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April 23, 2026

The Influence of Peripheral Artery Disease on Postoperative Complications Following Open Reduction and Internal Fixation for Ankle Fractures

Key Points

Evaluate the impact of peripheral artery disease on postoperative complications following ankle open reduction and internal fixation.
Queried TriNetX Research Network for patients undergoing isolated ankle ORIF.
Patients classified with or without PAD based on prior diagnosis within 6 months.
Propensity score matching used to balance demographics and comorbidities.
At 90 days, PAD patients had higher rates of surgical site infection (5.5% vs 2.0%) and wound disruption (10.2% vs 3.9%).
At 2 years, PAD was linked to higher risks of nonunion (RR 3.07) and chronic osteomyelitis (RR 8.42).
Increased risks of implant infection (RR 3.19) and below-knee amputation (RR 10.5) were observed.

Abstract

Background: Peripheral artery disease (PAD) has been associated with an increased risk of wound complications and surgical site infection following open reduction and internal fixation (ORIF) for ankle fractures. However, longer-term outcomes, including fracture healing, remain poorly characterized. This study evaluates the association between PAD and short- and long-term postoperative complications following ankle ORIF. Methods: The TriNetX Research Network was queried to identify patients who underwent isolated unimalleolar, bimalleolar, trimalleolar, or syndesmotic ORIF for ankle fractures. Patients were classified as having PAD if they had a documented diagnosis within 6 months before surgery, whereas patients without PAD served as controls. PAD and non-PAD cohorts were 1:1 propensity score matched for demographics and medical comorbidities. Postoperative complications were assessed at 90 days and 2 years. Results: After propensity matching, 2,159 patients were included in each cohort. At 90 days, patients with PAD had markedly higher rates of surgical site infection (5.5% vs 2.0%), wound disruption (10.2% vs 3.9%), lower extremity cellulitis (7.6% vs 2.1%), and acute osteomyelitis of the ankle or foot (3.1% vs 0.6%) (all P < 0.001). At 2 years, PAD was associated with increased risks of nonunion (RR 3.07, 95% CI, 1.69 to 5.60), chronic osteomyelitis (RR 8.42, 95% CI, 4.64 to 15.27), implant infection (RR 3.19, 95% CI, 2.47 to 4.11), implant removal (RR 1.54, 95% CI, 1.32 to 1.81), and below-knee amputation (RR 10.5, 95% CI, 5.50 to 20.03) (all P ≤ 0.0001). Conclusions: PAD is associated with markedly increased short- and long-term complications following ankle ORIF, including a sustained risk of impaired fracture healing. These findings underscore the importance of long-term risk stratification in patients with PAD undergoing ankle fracture fixation.

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