{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:12:33Z","timestamp":1788444753745,"version":"build-2803163510"},"reference-count":24,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ActaO"],"abstract":"<jats:p>Background and purpose:\u00a0Ankle fractures are common, and open reduction and internal fixation (ORIF) is standard treatment for unstable injuries. Surgical site infections (SSI) remain a significant clinical challenge. We aimed to estimate incidence and to identify patient- and treatment-related factors associated with SSI after ankle ORIF.Methods:\u00a0In this retrospective cohort, we included all adults (\u2265 18 years) who underwent ankle ORIF at 2 trauma centers in northern Sweden from 2015 to 2024. Data from medical records covered demographics, comorbidities, injury characteristics, surgical details, and peri\/postoperative care. The primary outcome was incidence of SSI and the secondary outcome was independent factors associated with SSI. SSI was defined as an infection occurring at or near the surgical incision within 30 days after surgery or up to 1 year later in the presence of an implant.Results:\u00a0We included 781 patients (mean age 54 years; 61% women). SSI occurred in 11%; 27% of infections underwent revision surgery, and 39 infections (43%) were categorized as fracture-related infection (FRI). Other complications included urinary tract infections (2.2%), pneumonia (0.8%), deep vein thrombosis (0.5%), and pulmonary embolism (0.4%). In adjusted analyses, higher odds of SSI were observed with smoking (aOR 2.3, 95% confidence interval [CI] 1.1\u20134.8, P = 0.02), initial external fixation (aOR 5.6, CI 1.7\u201317.6, P = 0.004), and longer operative time (OR per minute 1.0, CI 1.0\u20131.0, P = 0.004). The American Society of Anesthesiologists (ASA) class estimate suggested increased risk but was imprecise (aOR 9.7, CI 1.0\u201393.6, P = 0.049). Age, sex, and open fracture were not associated with SSI in the adjusted model.Conclusion:\u00a0After ankle ORIF, SSI occurred in 11%. Smoking, initial external fixation, and longer operative time were associated with higher risk of infection, while ASA estimate was imprecise. These findings support perioperative risk mitigation (e.g., smoking cessation and operative efficiency) and motivate study of physiological risk (ASA).<\/jats:p>","DOI":"10.2340\/17453674.2026.46313","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T13:16:37Z","timestamp":1788441397000},"source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with surgical site infection after ankle fracture fixation: a retrospective study in northern Sweden"],"prefix":"10.2340","volume":"97","author":[{"given":"Serta\u00e7","family":"Topalhafizoglu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Str\u00e5lmark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rickard","family":"Lundqvist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"W\u00e4nman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grzegorz","family":"Pietz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"167333","doi-asserted-by":"crossref","unstructured":"Basques B A, Miller C P, Golinvaux N S, Bohl D D, Grauer J N. Morbidity and readmission after open reduction and internal fixation of ankle fractures are associated with preoperative patient characteristics. Clin Orthop Relat Res 2015; 473(3): 1133-9. doi: 10.1007\/s11999-014-4005-z.","DOI":"10.1007\/s11999-014-4005-z"},{"key":"167334","doi-asserted-by":"crossref","unstructured":"Gundtoft P H, Pedersen A B, Viberg B. Incidence, treatment, and mortality of ankle fractures: a Danish population-based cohort study. Acta Orthop 2025; 96: 203-8. doi: 10.2340\/17453674.2025.43006.","DOI":"10.2340\/17453674.2025.43006"},{"key":"167335","doi-asserted-by":"crossref","unstructured":"Aigner R, Salomia C, Lechler P, Pahl R, Frink M. Relationship of prolonged operative time and comorbidities with complications after geriatric ankle fractures. Foot Ankle Int 2017; 38(1): 41-8. doi: 10.1177\/1071100716667315.","DOI":"10.1177\/1071100716667315"},{"key":"167336","doi-asserted-by":"crossref","unstructured":"Davidovitch R I, Walsh M, Spitzer A, Egol K A. Functional outcome after operatively treated ankle fractures in the elderly. Foot Ankle Int 2009; 30(8): 728-33. doi: 10.3113\/FAI.2009.0728.","DOI":"10.3113\/FAI.2009.0728"},{"key":"167337","doi-asserted-by":"crossref","unstructured":"Thangarajah T, Prasad P S V, Narayan B. Surgical site infections following open reduction and internal fixation of ankle fractures. Open Orthop J 2009; 22(3): 56-60. doi: 10.2174\/1874325000903010056.","DOI":"10.2174\/1874325000903010056"},{"key":"167338","doi-asserted-by":"crossref","unstructured":"Sporer S M, Weinstein J N, Koval K J. The geographic incidence and treatment variation of common fractures of elderly patients. J Am Acad Orthop Surg 2006; 14(4): 246-55. doi: 10.5435\/00124635-200604000-00006.","DOI":"10.5435\/00124635-200604000-00006"},{"key":"167339","doi-asserted-by":"crossref","unstructured":"Lynde M J, Sautter T, Hamilton G A, Schuberth J M. Complications after open reduction and internal fixation of ankle fractures in the elderly. Foot Ankle Surg 2012; 18(2): 103-7. doi: 10.1016\/j.fas.2011.03.010.","DOI":"10.1016\/j.fas.2011.03.010"},{"key":"167340","doi-asserted-by":"crossref","unstructured":"Anderson S A, Li X, Franklin P, Wixted J J. Ankle fractures in the elderly: initial and long-term outcomes. Foot Ankle Int 2008; 29(12): 1184-8. doi: 10.3113\/FAI.2008.1184.","DOI":"10.3113\/FAI.2008.1184"},{"key":"167341","doi-asserted-by":"crossref","unstructured":"Chaudhary S B, Liporace F A, Gandhi A, Donley B G, Pinzur M S, Lin S S. Complications of ankle fracture in patients with diabetes. J Am Acad Orthop Surg 2008; 16(3): 159-70. doi: 10.5435\/00124635-200803000-00007.","DOI":"10.5435\/00124635-200803000-00007"},{"key":"167342","doi-asserted-by":"crossref","unstructured":"Korim M T, Payne R, Bhatia M. A case-control study of surgical site infection following operative fixation of fractures of the ankle in a large U.K. trauma unit. Bone Joint J 2014; 96-B(5): 636-40. doi: 10.1302\/0301-620X.96B5.33143.","DOI":"10.1302\/0301-620X.96B5.33143"},{"key":"167343","doi-asserted-by":"crossref","unstructured":"Miller A G, Margules A, Raikin S M. Risk factors for wound complications after ankle fracture surgery. J Bone Joint Surg Am 2012; 94(22): 2047-52. doi: 10.2106\/JBJS.K.01088.","DOI":"10.2106\/JBJS.K.01088"},{"key":"167344","doi-asserted-by":"crossref","unstructured":"Ovaska M. Complications in ankle fracture surgery. Acta Orthop 2015; 86(Suppl 358): 1-32. doi: 10.3109\/17453674.2014.100227.","DOI":"10.3109\/17453674.2014.1002273"},{"key":"167345","doi-asserted-by":"crossref","unstructured":"Ovaska M T, M\u00e4kinen T J, Madanat R, Huotari K, Vahlberg T, Hirvensalo E, et al. Risk factors for deep surgical site infection following operative treatment of ankle fractures. J Bone Joint Surg Am 2013; 95(4): 348-53. doi: 10.2106\/JBJS.K.01672.","DOI":"10.2106\/JBJS.K.01672"},{"key":"167346","doi-asserted-by":"crossref","unstructured":"Nasell H, Ottosson C, T\u00f6rnqvist H, Linde J, Ponzer S. The impact of smoking on complications after operatively treated ankle fractures: a follow-of study of 906 patients. J Orthop Trauma 2011; 25(12): 748-55. doi: 10.1097\/BOT.0b013e318213f217.","DOI":"10.1097\/BOT.0b013e318213f217"},{"key":"167347","doi-asserted-by":"crossref","unstructured":"Naumann M G, Sigurdsen U, Utvag S E, Stavem K. Incidence and risk factors for removal of an internal fixation following surgery for ankle fracture: a retrospective cohort study of 997 patients. Injury 2016; 47(8): 1783-8. doi: 10.1016\/j.injury.2016.05.011.","DOI":"10.1016\/j.injury.2016.05.011"},{"key":"167348","doi-asserted-by":"crossref","unstructured":"Shao J, Zhang H, Yin B, Li J, Zhu Y, Zhang Y. Risk factors for surgical site infection following operative treatment of ankle fractures: a systematic review and meta-analysis. Int J Surg 2018; 56: 124-32. doi: 10.1016\/j.ijsu.2018.06.018.","DOI":"10.1016\/j.ijsu.2018.06.018"},{"key":"167349","doi-asserted-by":"crossref","unstructured":"Metsemakers W, Morgenstern M, McNally, Moriarty T F, McFadyen I, Scarborough M, et al. Fracture-related infection: a consensus on definition from an international expert group. Injury 2018; 3: 505-10. doi: 10.1016\/j.injury.2017.08.040.","DOI":"10.1016\/j.injury.2017.08.040"},{"key":"167350","doi-asserted-by":"crossref","unstructured":"Tausendfreund J, Penning D, Naryapragi M A, Reisinger K W, Tanis E, Joosse P, et al. Predicting surgical site infections after open reduction and internal fixation for ankle fractures. Arch Orthop Trauma Surg 2025; 145(1): 135. doi: 10.1007\/s00402-024-05623-9.","DOI":"10.1007\/s00402-024-05623-9"},{"key":"167351","doi-asserted-by":"crossref","unstructured":"Meng J, Sun T, Zhang F, Qin S, Li Y, Zhao H. Deep surgical site infection after ankle fractures treated by open reduction and internal fixation in adults: a retrospective case-control study. Int Wound J 2018; 15(6): 971-7. doi: 10.1111\/iwj.12957.","DOI":"10.1111\/iwj.12957"},{"key":"167352","doi-asserted-by":"crossref","unstructured":"Sun R, Mingqiao M, Xiaofeng W, Xiaodong L, Wu L, Chen Z, et al. Surgical site infection following open reduction and internal fixation of a closed ankle fractures: a retrospective multicenter cohort study. Int J Surg 2017; 48: 86-91. doi: 10.1016\/j.ijsu.2017.10.002.","DOI":"10.1016\/j.ijsu.2017.10.002"},{"key":"167353","doi-asserted-by":"crossref","unstructured":"Sun Y, Wang H, Tang Y, Zhao H, Qin S, Xu L. Incidence and risk factors for surgical site infection after open reduction and internal fixation of ankle fracture: a retrospective multicenter study. Medicine (Baltimore) 2018; 97(7): e9901. doi: 10.1097\/MD.0000000000009901.","DOI":"10.1097\/MD.0000000000009901"},{"key":"167354","doi-asserted-by":"crossref","unstructured":"Saithna A, Moody M, Jenkinson E, Almazedi B. The influence of timing of surgery on soft tissue complications in closed ankle fractures. Eur J Orthop Surg Traumatol 2009; 19(7): 481-4. doi:10.1007\/s00590-009-0455-5.","DOI":"10.1007\/s00590-009-0455-5"},{"key":"167355","doi-asserted-by":"crossref","unstructured":"Tan L T, Oh J Y, Kwek E B K. Infection rates in Singaporeans with and without complicated diabetes after ankle fracture surgery. 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