Infection following operative treatment of ankle fractures

Clin Orthop Relat Res. 2009 Jul;467(7):1715-20. doi: 10.1007/s11999-009-0743-8. Epub 2009 Feb 19.


Information on the microbiology of infections after operative ankle fractures, on the details of a treatment protocol used when the ankle joint is preserved, and on the outcome of this protocol will be helpful for the physicians managing patients with this complex problem. We therefore determined the most common pathogen of these infections, the infection recurrence rate, and the amputation rate. We retrospectively reviewed 26 patients of a mean age of 43 years with infections following operative treatment of ankle fractures. Twenty-one of 26 patients (81%) were compromised hosts according to the Cierny-Mader classification. Patients presenting up to 10 weeks postoperatively were treated by débridement and either hardware retention (if implants were judged stable) or hardware removal (if implants were loose). All patients presenting more than 10 weeks postoperatively underwent débridement and hardware removal, with the exception of one patient who underwent below knee amputation. Staphylococcus aureus was identified in 17 patients (65%) and was oxacillin-resistant in six (23%). The infection recurred in five of 18 patients who were followed up for 8 months on average. Three recurrent infections were controlled with repeat débridement. The remaining two patients underwent below-knee amputation, resulting in amputations in 3 of 18 patients. Infection after operative treatment of ankle fractures is a limb-threatening complication, especially in patients with comorbidities, such as diabetes mellitus. Treatment is challenging with high infection recurrence and amputation rates.

Level of evidence: Level IV, therapeutic study case series.

MeSH terms

  • Adult
  • Aged
  • Amputation, Surgical / statistics & numerical data
  • Ankle Injuries / epidemiology*
  • Ankle Injuries / surgery*
  • Anti-Bacterial Agents / therapeutic use
  • Comorbidity
  • Debridement / statistics & numerical data
  • Female
  • Fractures, Bone / epidemiology*
  • Fractures, Bone / surgery*
  • Humans
  • Internal Fixators / statistics & numerical data
  • Male
  • Middle Aged
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / epidemiology
  • Staphylococcal Infections / surgery
  • Surgical Flaps / statistics & numerical data
  • Surgical Wound Infection / drug therapy
  • Surgical Wound Infection / epidemiology*
  • Surgical Wound Infection / surgery
  • Young Adult


  • Anti-Bacterial Agents