Information on surgical site infection (SSI) after surgical treatment of ankle fracture is limited and remains controversial. The purpose of the present study was to determine the incidence and risk factors for SSI after open reduction and internal fixation (ORIF) of ankle fracture. Patients who underwent ORIF for ankle fracture at 3 centers between January 2015 and December 2016 were included. The potential risk factors for SSI included demographic variables, including age, sex, body mass index (BMI), hypertension, diabetes mellitus, heart disease, smoking, and excessive alcohol intake; blood test variables including preoperative white blood cell count, neutrophil count, red blood cell count, hemoglobin, total protein, albumin and globulin; injury- and surgery-related variables, including duration of operation (minutes), intraoperative blood loss, surgeon level, fracture site, accompanied dislocation, use of a drainage tube, and antibiotic use. Factors related with SSI occurrence were investigated by univariate analysis, and then by multivariate analysis. During hospitalization, 4.37% (66/1511) of patients developed SSI, which was deep in 1.32% (20/1510) and superficial in 3.05% (46/1510). The most common causative agent was polymicrobial (causing approximately half of all SSIs), followed by methicillin-resistant Staphylococcus aureus (MRSA). Multivariate analysis revealed that the significant risk factors for SSI occurrence were open injury, advanced age, incision cleanliness II – IV, high-energy injury, more experienced surgeon level, greater BMI, chronic heart disease, history of allergy, and preoperative neutrophil count > 75%. Preoperative preventative measures should be taken in patients with these conditions to lower the incidence of SSI after ORIF of ankle fracture.LEVEL OF EVIDENCE: Level III - Retrospective Comparative Study.

No abstract

This study aimed to report our institution's experience in the diagnosis and treatment of chronic lateral ankle instability (CLAI) with ligamentum bifurcatum (LB) injury.This retrospective study included 218 consecutive patients with CLAI who underwent surgery from January 2012 to December 2015. The 218 patients received tendon allograft reconstruction of the lateral ligament. CLAI was combined with LB injury in 51.4% (112/218) of patients. The 112 patients with concurrent LB injury had this treated simultaneously; 36 patients underwent excision of the anterior process of the calcaneus, 68 underwent LB repair, and 8 underwent LB reconstruction. Patients returned for a clinical and radiologic follow-up evaluation at an average of 31 (range, 24–35) months postoperatively. Outcomes were assessed by comparison of pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual analog scale pain scores, Karlsson scores, and radiographic assessment.Of the patients with concurrent LB injury, 82.1% (92/112) returned for final evaluation. Postoperatively, most patients recovered very well. However, the outcome was not ideal in those who underwent excision of the anterior process of the calcaneus; there were significant postoperative decreases in talar tilt (P < .05) and anterior drawer (P < .05), but there was no significant postoperative improvement in visual analog scale pain score and AOFAS score. Patients who underwent LB repair or reconstruction had an excellent or good outcome regarding patient subjective self-assessment, pain scores, Karlsson scores, and AOFAS scores at final follow-up.Patients with CLAI often have concurrent LB injury. The diagnosis of LB injury can be missed or delayed. Clinicians should closely examine the LB in cases of CLAI, and should surgically repair or reconstruct the LB when necessary.