Risk factors for complications after ankle fracture surgery: a review of 531 cases

Ankle fractures are a common injury, and they are often treated with surgery. This study aimed to identify the risk factors for minor and major complications following ankle fracture surgery at a regional hospital in Singapore.

Data of patients with ankle fractures treated with surgery at a hospital in Singapore between January 2016 and December 2022 was collected. Cases were identified through surgical logs containing codes for ankle fracture surgery. Patient case notes were reviewed to collect demographic data and to identify post-operative complications.

A total of 531 cases were included. The overall complication rate was 37% with a minor complication rate of 29.7% and a major complication rate of 7.3%. Risk factors for overall complications were female sex (OR 1.4, p = 0.04), ASA grade 3 (OR 3.4, p < 0.01), diabetes mellitus (OR 2.2, p = 0.002), renal disease (OR 4.4, p = 0.007), peripheral vascular disease (OR 14.1, p = 0.001), open fractures (OR 5.2, p = 0.02), Weber C fractures (OR 1.8, p = 0.005), fractures involving two malleoli (OR 1.7, p = 0.018), fractures involving three malleoli (OR 1.8, p = 0.010) and intramedullary fixation (OR 2.9, p = 0.014). Risk factors for major complications were diabetes (OR 3.7, p = 0.012), open fractures (OR 23.7, p < 0.001) and the use of intramedullary fixation (OR 10.2, p < 0.001).

Our series found a 7.3% risk of major complications and a 29.7% risk of minor complications in surgery for ankle fractures. Female sex is a risk factor for minor complications on multivariate analysis. Diabetes, open fracture and intramedullary fixation were risk factors for major complications on multivariate analysis.