Always Go Too Far Because That ́ S Where You ’ Ll Find the Truth –

ABSTRACT Mikko Ovaska. Complications in Ankle Fracture Surgery. Helsinki Bone and Joint Research Group, Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, University of Helsinki, Finland. Helsinki 2014. Ankle fractures are among the most common surgically treated fractures. The operative treatment of this fracture may be associated with several complications. The most frequently encountered complications are related wound healing, and deep infection may have devastating consequences. As the population continues to age, the number of elderly patients with comorbidities sustaining ankle fractures continues to rise. In the future, an increase in complications related to ankle fracture surgery is expected. The purpose of this study was to investigate complications related to ankle fracture surgery. The study population consisted of 5123 consecutive ankle fracture patients, who were operatively treated at a level I-trauma center during the years 2002–2011. The study aimed to determine the most common technical errors resulting in early reoperation following ankle fracture surgery, and to identify the most important risk factors for deep surgical site infection (SSI) following operative treatment of ankle fractures. Additionally, the study aimed to assess the outcome of patients with flap reconstruction following deep infection with exposed hardware, and to recognize the main factors predisposing to a treatment failure of an infected ankle fracture. The study showed that problems related to syndesmot ic reduct ion together with fibular shortening were the most important indications for early reoperation following ankle fracture surgery. Several modifiable risk factors for deep infection were identified; most importantly, the multivariable analysis showed that smoking (OR = 3.7, 95% CI 1.6-8.5), and durat ion of surgery > 90 minutes (OR = 2.5, 1.1–5.7) were independent risk factors for deep infection. Cast application in the operating room was independently associated with a decresed infection rate (OR = 0.4, 95% CI 0.2-0.8). The study revealed that soft-tissue defects around ankle with infected hardware can be successfully treated