Risk factors and morbidity characteristics of surgical site infection following ankle fracture ORIF: A comprehensive analysis

This study aimed to describe the incidence and microbiological characteristics of surgical site infection (SSI) after open reduction and internal fixation (ORIF) of ankle fractures and identify clinical factors associated with SSI. This single-center retrospective cohort study included 248 patients who underwent ankle fracture ORIF between January and December 2023. SSI occurring within 30 postoperative days was identified from available inpatient and postoperative medical records. Demographic, injury-related, laboratory, and perioperative variables were compared between patients with and without SSI. Multivariable logistic regression was used to estimate adjusted associations with SSI. SSI occurred in 32 of 248 patients (12.9%), including 25 superficial and 7 deep infections. Cultured organisms included Escherichia coli (n = 10), Staphylococcus aureus (n = 7), Klebsiella pneumoniae (n = 6), Enterobacter cloacae (n = 5), and Staphylococcus epidermidis (n = 4). In multivariable analysis, open fracture, wound class II-III, and neutrophil percentage > 75% were associated with SSI. Age and body mass index (BMI) also showed positive associations, although the precise unit-specific effect sizes could not be reliably reconstructed from the archived statistical analysis; these comparatively large per-unit estimates should be interpreted cautiously because of the limited number of SSI events and potential residual confounding. SSI occurred in 12.9% of this single-center ankle fracture cohort. Older age and higher BMI showed associations with SSI, together with open fracture, less-clean operative wounds, and neutrophilia. The magnitude of the age- and BMI-related effects should be interpreted cautiously because their original regression scaling could not be independently reconstructed.