Perioperative Antibiotic Choice Does Not Affect Wound Complications in the Operative Treatment of Ankle Fractures

Background and aims Ankle injuries are one of the most common lower extremity traumas reported, with nearly half needing surgical intervention. For those who undergo surgical treatment, surgical site infection (SSI) is not a rare complication. Cefazolin is the recommended preoperative surgical chemoprophylaxis for surgical site infection. This exploratory study sought to evaluate the efficacy of cefazolin prophylaxis at the time of primary open reduction and internal fixation (ORIF) for ankle fractures compared to the efficacy of non-cefazolin chemoprophylaxis with respect to wound complications. Methods A single-center retrospective study of adult patients who underwent open reduction and internal fixation (ORIF) of a closed ankle fracture between January 1, 2012, and April 11, 2023, was conducted at Good Samaritan University Hospital. Patients were compared based on the perioperative antibiotic received per our hospital's guidelines: cefazolin (given by weight: 2 g < 120 kg and 3 g ≥ 120 kg) or a non-cefazolin alternative for a reported cefazolin or penicillin allergy (clindamycin 900 mg and/or vancomycin 1 g < 80 kg or 1.5 g ≥ 80 kg). Group 1 consisted of 132 patients who underwent ORIF of the ankle after having received cefazolin. Group 2 consisted of 19 patients who underwent ORIF of the ankle after having received a non-cefazolin antibiotic. The outcomes measured were postoperative infection, infection requiring surgery, and dehiscence. Associations between the American Society of Anesthesiologists (ASA) physical classification score, body mass index (BMI), and ankle fracture classification and our primary outcomes were also reviewed. Results Of the 151 patients, 22 patients were reported to have complications. Complications were defined as postoperative infection, infection requiring surgery, and dehiscence. There was no statistically significant difference in these complication rates (infection, p = 0.9; infection requiring surgery, p = 0.6; and dehiscence, p = 0.5) between the cefazolin and non-cefazolin cohorts. The average follow-up time after surgery in both groups was eight months. Conclusions There were no significant differences in complication rates between the cefazolin and non-cefazolin cohorts. In turn, prophylactic antibiotic type, among those reported in this study, does not appear to be a prominent influence on the rate of wound complications in ORIF of ankle fractures. The sample size of this study, however, is a major limitation. These results can help guide a larger study of the efficacy of antibiotic chemoprophylaxis choice in ankle ORIF surgeries.