Preoperative Risk Score for Predicting Delayed Wound Healing After Plate Fixation in Patients With Closed Distal Fibular Fractures

Background: Delayed wound healing after open reduction and internal fixation (ORIF) of distal fibular fractures can impair recovery and increase infection risk. The purpose of this study was to develop a simple preoperative scoring system to predict delayed wound healing after plate fixation in patients with closed distal fibular fractures. Methods: This retrospective cohort study reviewed 84 patients who underwent plate fixation for closed distal fibular fractures between 2018 and 2024. Delayed wound healing was defined as a surgical wound rated as Grade 2 or higher according to the Southampton Wound Assessment Scale postoperatively. The following preoperative variables were collected, binarized, and entered into a logistic regression model to develop a weighted risk score: age, diabetes mellitus status, fracture characteristics, and planned number of plates. Results: Delayed wound healing occurred in 30 patients. Multivariate analysis identified age ≥70 years, complex fracture type, and use of ≥2 plates as independent predictors of delayed wound healing. Presence of diabetes mellitus was retained for clinical relevance. Each predictor was weighted as follows: age and diabetes, one point each; fracture type and planned use of ≥2 plates, two points each. These scores demonstrated good predictive performance. Conclusion: We developed a simple preoperative scoring system for predicting delayed wound healing following ORIF for closed distal fibular fractures using four clinical variables, supporting early risk stratification. This model may aid in identifying high-risk patients preoperatively, allowing for informed surgical planning and individualized perioperative care to minimize wound complications.