Irish Journal of Medical Science

, Volume 182, Issue 3, pp 453–456 | Cite as

Risk factors for surgical site infection following operative ankle fracture fixation

  • E. G. KellyEmail author
  • J. P. Cashman
  • P. J. Groarke
  • S. F. Morris
Original Article



Ankle fracture is a common injury and there is an increasingly greater emphasis on operative fixation.


The purpose of the study was to determine the complication rate in this cohort of patients and, in doing so, determine risk factors which predispose to surgical site infection.


A prospective cohort study was performed at a tertiary referral trauma center examining risk factors for surgical site infection in operatively treated ankle fractures.


Univariate and multivariate analysis was performed. Female gender and advancing age were determined to be the risk factors in univariate analysis. Drain usage and peri-operative pyrexia were found to be significant for infection in multivariate analysis.


This study allows surgeons to identify those at increased risk of infection and counsel them appropriately. It also allows for a high level of vigilance with regard to soft tissue handling intra-operatively in this higher risk group.


Ankle Fracture  Infection Risk factors Open reduction internal fixation 


Conflict of interest



  1. 1.
    Sporer SM, Weinstein JN, Koval KJ (2006) The geographic incidence and treatment variation of common fractures of elderly patients. J Am Academy of Orthop Surg 14(4):246–255Google Scholar
  2. 2.
    Leininger RE, Knox CL, Comstock RD (2007) Epidemiology of 1.6 million pediatric soccer-related injuries presenting to US emergency departments from 1990 to 2003. Am J Sports Med 35(2):288–293PubMedCrossRefGoogle Scholar
  3. 3.
    Sanders DW, Tieszer C, Corbett B (2012) Operative versus nonoperative treatment of unstable lateral malleolar fractures: a randomized multicenter trial. J Orthop Trauma 26(3):129–134PubMedCrossRefGoogle Scholar
  4. 4.
    Makwana NK, Bhowal B, Harper WM, Hui AW (2001) Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age. A prospective, randomised study. J Bone Joint Surg Br 83(4):525–529PubMedCrossRefGoogle Scholar
  5. 5.
    Bray TJ, Endicott M, Capra SE (1989) Treatment of open ankle fractures. Immediate internal fixation versus closed immobilization and delayed fixation. Clin Orthop Relat Res 240:47–52PubMedGoogle Scholar
  6. 6.
    Michelson JD (1995) Fractures about the ankle. J Bone Joint Surg Am 77(1):142–152PubMedGoogle Scholar
  7. 7.
    Vegas AA, Jodra VM, Garcia ML (1993) Nosocomial infection in surgery wards: a controlled study of increased duration of hospital stays and direct cost of hospitalization. Eur J Epidemiol 9(5):504–510PubMedGoogle Scholar
  8. 8.
    Dellenbaugh SG, Dipreta JA, Uhl RL (2011) Treatment of ankle fractures in patients with diabetes. Orthopedics 34(5):385PubMedGoogle Scholar
  9. 9.
    Zgonis T, Jolly GP, Garbalosa JC (2004) The efficacy of prophylactic intravenous antibiotics in elective foot and ankle surgery. J Foot Ankle Surg 43(2):97–103PubMedCrossRefGoogle Scholar
  10. 10.
    Alexander JW, Solomkin JS, Edwards MJ (2011) Updated recommendations for control of surgical site infections. Ann Surg 253(6):1082–1093PubMedCrossRefGoogle Scholar
  11. 11.
    Lindsjo U (1985) Operative treatment of ankle fracture-dislocations. A follow-up study of 306/321 consecutive cases. Clin Orthop Relat Res 199:28–38PubMedGoogle Scholar
  12. 12.
    SooHoo NF, Krenek L, Eagan MJ, Gurbani B, Ko CY, Zingmond DS (2009) Complication rates following open reduction and internal fixation of ankle fractures. J Bone Joint Surg Am 91(5):1042–1049PubMedCrossRefGoogle Scholar
  13. 13.
    Srinivasan CM, Moran CG (2001) Internal fixation of ankle fractures in the very elderly. Injury 32(7):559–563PubMedCrossRefGoogle Scholar
  14. 14.
    Anderson SA, Li X, Franklin P, Wixted JJ (2008) Ankle fractures in the elderly: initial and long-term outcomes. Foot & ankle international/American Orthopaedic Foot and Ankle Society (and) Swiss Foot and Ankle. Society 29(12):1184–1188Google Scholar
  15. 15.
    Thangarajah T, Prasad PS, Narayan B (2009) Surgical site infections following open reduction and internal fixation of ankle fractures. Open Orthop J 3:56–60PubMedCrossRefGoogle Scholar
  16. 16.
    Egol KA, Tejwani NC, Walsh MG, Capla EL, Koval KJ (2006) Predictors of short-term functional outcome following ankle fracture surgery. J Bone Joint Surg Am 88(5):974–979PubMedCrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2013

Authors and Affiliations

  • E. G. Kelly
    • 1
    Email author
  • J. P. Cashman
    • 1
  • P. J. Groarke
    • 1
  • S. F. Morris
    • 1
  1. 1.Department of Orthopaedic SurgeryAMNCHDublinIreland

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