Risk Factors for Infectious and Soft Tissue Complications in Ankle Fracture Dislocations

Category: Trauma; Ankle Introduction/Purpose: Ankle fracture-dislocations (AFD) are violent injuries with reported worse prognosis compared to their non-dislocated counterparts. There is limited literature describing the demographic characteristics and risk factors for complications for these injuries. This study analyzed risk factors for deep surgical site infection and wound complications in AFDs. Methods: Ankle Fractures from 2013 to 2023 at a single Level I trauma center were reviewed. Patients with complete tibiotalar dislocation defined by absolute articular incongruity in either the lateral or anteroposterior radiographic views were included. Patients with pan-talar dislocations and those who were already successfully reduced at outside institutions were excluded. Successful reduction was defined as near anatomic articular congruity with less than 5 millimeters of medial clear space. Demographic characteristics were recorded. Primary outcomes assessed were deep surgical site infection (SSI), and wound complications. Wound complications were stratified into categories defined as delay in healing, superficial wound dehiscence, and deep wound dehiscence. Demographic and clinical characteristics were compared across primary outcomes using the Chi-Square test for categorical variables and the Student’s t-test, with the Fisher Exact test being used if the data were not normally distributed. Results: 113 patients were reviewed and met inclusion criteria. 15 had deep SSI. 75 had normal wound healing, 17 had delayed wound healing, 7 had superficial wound dehiscence, and 14 had deep wound dehiscence. Open fracture incidence was significantly associated with older age (p < 0.03). Neuropathy, open fractures, peripheral vascular disease, and polysubstance abuse were associated with deep SSI (p < 0.02, p< 0.05, p< 0.03, p< 0.05, respectively). Open fractures, chronic kidney disease, and polysubstance abuse were associated with overall wound complication occurrence (p < 0.01, p< 0.02, p< 0.04, respectively). Open fractures, neuropathy, and polysubstance abuse were associated with deep wound dehiscence (p < 0.05, p< 0.05, p< 0.05, respectively). There was no association between successful closed reduction and SSI or wound healing complications (p=.98, p=.744, respectively). Conclusion: The overall deep SSI prevalence in our cohort was 13%. Open fractures, neuropathy, and polysubstance abuse were significant risk factors for both SSI and wound healing complications. Successful anatomic reduction of ankle fracture dislocation was not associated with SSI or wound healing complications.