The Influence of Peripheral Artery Disease on Postoperative Complications Following Open Reduction and Internal Fixation for Ankle Fractures

BACKGROUND: Peripheral artery disease (PAD) has been associated with an increased risk of wound complications and surgical site infection following open reduction and internal fixation (ORIF) for ankle fractures. However, longer-term outcomes, including fracture healing, remain poorly characterized. This study evaluates the association between PAD and short- and long-term postoperative complications following ankle ORIF. METHODS: The TriNetX Research Network was queried to identify patients who underwent isolated unimalleolar, bimalleolar, trimalleolar, or syndesmotic ORIF for ankle fractures. Patients were classified as having PAD if they had a documented diagnosis within 6 months before surgery, whereas patients without PAD served as controls. PAD and non-PAD cohorts were 1:1 propensity score matched for demographics and medical comorbidities. Postoperative complications were assessed at 90 days and 2 years. RESULTS: After propensity matching, 2,159 patients were included in each cohort. At 90 days, patients with PAD had markedly higher rates of surgical site infection (5.5% vs 2.0%), wound disruption (10.2% vs 3.9%), lower extremity cellulitis (7.6% vs 2.1%), and acute osteomyelitis of the ankle or foot (3.1% vs 0.6%) (all P < 0.001). At 2 years, PAD was associated with increased risks of nonunion (RR 3.07, 95% CI, 1.69 to 5.60), chronic osteomyelitis (RR 8.42, 95% CI, 4.64 to 15.27), implant infection (RR 3.19, 95% CI, 2.47 to 4.11), implant removal (RR 1.54, 95% CI, 1.32 to 1.81), and below-knee amputation (RR 10.5, 95% CI, 5.50 to 20.03) (all P ≤ 0.0001). CONCLUSIONS: PAD is associated with markedly increased short- and long-term complications following ankle ORIF, including a sustained risk of impaired fracture healing. These findings underscore the importance of long-term risk stratification in patients with PAD undergoing ankle fracture fixation.