JAAOS - 2026-07-15 - Journal Article
Patient Demographics and Risk Factors for Surgical Site Infections After Open Reduction and Internal Fixation for Bimalleolar Ankle Fractures.
Mastrokostas PG, Monas A, Rodriguez AN, Lam A, Razi AE, Ng MK
Topics
Key Takeaway
SSI incidence after ORIF for bimalleolar ankle fractures was 3.1%, with peripheral vascular disease carrying the highest independent risk (OR 1.62).
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Summary
This study used the PearlDiver Mariner Database to identify SSI incidence and independent risk factors after ORIF for bimalleolar ankle fractures from 2010 to 2021. SSI occurred in 3.1% of patients; multivariate logistic regression identified nine independent risk factors including peripheral vascular disease (OR 1.62), fluid/electrolyte disorders (OR 1.42), hypertension (OR 1.29), diabetes (OR 1.27), and tobacco use (OR 1.25). Male sex, CKD, drug abuse, and weight loss were also independently associated with SSI.
Key Limitation
The database lacks fracture-specific variables (Gustilo-Anderson grade, soft tissue status, fracture displacement, time to surgery) that are primary determinants of SSI risk and cannot be controlled for in the analysis.
Original Abstract
BACKGROUND
The purpose of this study was to identify the incidence and risk factors associated with surgical site infection (SSI) after open reduction and internal fixation of bimalleolar ankle fractures. Bimalleolar ankle fractures are one of the most common subtypes of ankle fractures, accounting for 15% to 20% of all ankle fractures. Recent studies have shown that 4.37% of patients undergoing ORIF of ankle fractures develop an SSI postoperatively. The literature detailing the risk factors for the development of SSI after open reduction and internal fixation (ORIF) of bimalleolar ankle fractures is sparse. Therefore, the purpose of this study was to determine the risk factors that predispose patients to SSI after the index procedure.
METHODS
Patients who underwent bimalleolar ankle fracture repair between January 1, 2010, and December 31, 2021, were identified using the PearlDiver Mariner Database. Demographics and comorbidities between SSI and non-SSI cohorts were compared through chi-square analysis. Multivariate logistic regression was used to analyze risk factors for SSIs. A P value less than 0.001 was determined to be statistically significant.
RESULTS
The incidence of SSI after ORIF of bimalleolar ankle fractures was 3.1%. Age, sex, and a higher total Elixhauser Comorbidity Index were associated with an increased incidence of SSI ( P < 0.0001). Risk factors for the development of SSI included male sex (OR = 1.17; P < 0.0001), chronic kidney disease (odds ratio [OR] = 1.233; P < 0.001), diabetes (OR = 1.27; P < 0.0001), drug abuse (OR = 1.22; P < 0.0001), fluid and electrolyte disorders (OR = 1.42; P < 0.0001), hypertension (OR = 1.29; P < 0.0001), peripheral vascular disease (OR = 1.62; P < 0.0001), tobacco use (OR = 1.25; P < 0.0001), and weight loss (OR = 1.25; P < 0.0001). Peripheral vascular disease was the most highly correlated risk factor for the development of SSIs in this study.
CONCLUSIONS
These findings underscore the importance of preoperative risk stratification and optimization to minimize SSIs in this population. This is the first study to delineate the risk factors for the development of SSI in patients undergoing ORIF for bimalleolar ankle fractures. Physicians can use these results to counsel patients before undergoing the index procedure to minimize postoperative infections.
LEVELS OF EVIDENCE
IV.