ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2026
Identification and treatment results for fracture-related infections following operative repair of a rotational ankle fractures.
Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe purpose of this study was to identify risk factors for confirmed fracture-related infection (FRI) following ankle fracture surgery and to report on the treatment of FRI after ankle fracture surgery.
methodsRetrospective chart review was performed on a consecutive series of ankle fracture surgery patients identified from a prospective database. Included patients had open or closed rotational ankle fracture definitively treated with internal fixation and age ≥ 18 years. The FRI cohort included patients with a confirmed FRI per the FRI Consensus Group. Baseline demographics, injury information, and infection characteristics were collected from the EMR. The FRI cohort was statistically compared to a control cohort. LASSO logistic regression with 1000 bootstrapped iterations was conducted to identify risk factors for ankle FRI.
resultsOf 480 patients who underwent operative treatment for a rotational ankle fracture, 37 (7.7%) developed a confirmed FRI at a mean of 43.77 ± 50.68 days post-operatively. FRI patients were more frequently on preoperative anticoagulants (p = 0.002) and more likely to have sustained high-energy injuries (p = 0.016), open fractures (p < 0.001), fracture-dislocations (p = 0.013), and required external fixation (p < 0.001). They also had significantly longer surgeries (p < 0.001). Bootstrapped LASSO regression identified open wound status, length of surgery, drug use, external fixation, and preoperative anticoagulant use as potential predictors of FRI, however, none demonstrated significant independent associations. Of the 37 patients in the FRI cohort, 35 (94.5%) were culture positive. Patients in the FRI cohort underwent an average of 2.46 ± 2.19 reoperations with 27 (73.0%) requiring hardware removal. 33 of 37 patients (89%) experienced resolution of their FRI.
conclusionWhile many factors may influence the development of FRI following rotational ankle fracture surgery, there were no variables robust enough to be independently significant in this cohort. However, there was an 89% resolution rate, suggesting that majority of patients with ankle FRI can be successfully treated. LEVEL OF EVIDENCE: Prognostic Level III.
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