Post-operative infection following ankle fracture surgery: a current concepts review

Purpose: The most common early complication of operative treatment of ankle fractures is a surgical site infection (SSI) with an incidence rate varying between 1.5 and 16%, depending on various risk factors. A SSI has multiple disadvantages, including worse outcome and a socio-economic burden. The aim of this review is to provide an updated overview of the current concepts pertinent to SSI in ankle fractures. Methods: A descriptive literature review was performed to provide the overview. Results: Well known risk factors for SSI are higher age, diabetes, open fractures and fracture dislocation. Diagnostic testing for infection include laboratory results (CRP, white blood cell count, leucocyte count), radiological imaging methods (conventional imaging, CT-scan, MRI-scan, 3-phase bone scan, FDG-PET) and microbiological deep tissue sampling. Treatment options for SSI are varied and include fracture reduction, antibiotic therapy with intravenous and oral treatment, surgical debridement and irrigation, transposition flaps in case of soft tissue defects with implant exposure and arthrodesis in severe infection with septic arthritis. Multiple studies show worse outcome scores in patients who develop a SSI. Prevention is important to reduce the rate of SSI. Surgery within 24 h decreases the risk of complications, compared to surgery performed in a delayed fashion. Appropriate timing and dosing of preoperative antibiotic prophylaxis is necessary. Conclusion: This review described the most frequent risk factors, appropriate diagnostic testing methods, an oversight of treatment options, gives insight in the outcome and mentioned prevention measurements for SSI after ORIF in ankle fractures.