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Background <p>The 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.</p> Methods <p>Retrospective 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.</p> Results <p>Of 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 (<i>p</i> = 0.002) and more likely to have sustained high-energy injuries (<i>p</i> = 0.016), open fractures (<i>p</i> &lt; 0.001), fracture-dislocations (<i>p</i> = 0.013), and required external fixation (<i>p</i> &lt; 0.001). They also had significantly longer surgeries (<i>p</i> &lt; 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.</p> Conclusion <p>While 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.</p> Level of evidence <p>Prognostic Level III.</p>

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Identification and treatment results for fracture-related infections following operative repair of a rotational ankle fractures

  • 期刊论文

  • 发表日期：

    2026年2月10日

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  • Nina D. Fisher,
  • Lauren A. Merrell,
  • Manasa Kadiyala,
  • Abhishek Ganta,
  • Sanjit R. Konda,
  • Kenneth A. Egol

摘要

Background

The 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.

Methods

Retrospective 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.

Results

Of 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.

Conclusion

While 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.