Treatment of superficial wound infection following open reduction and internal fixation of ankle fractures: A scoping review

INTRODUCTION: Ankle fractures account for approximately 10% of fractures among adults and frequently require surgical intervention, with open reduction and internal fixation being the gold standard. This intervention is associated with a high complication rate. Superficial infections can easily progress due to limited soft-tissue coverage. It is therefore vital to treat early infection. This study has aimed to map the treatments of superficial infection, following open reduction and internal fixation of ankle fractures. METHODS: This scoping review was conducted in accordance with the Joanna Briggs Institute methodology approach for scoping reviews. A comprehensive search strategy was used to identify relevant articles and thereafter selected through a two-step process by two independent authors. RESULTS: A total of 13,204 articles were identified, of which 18 articles including 146 cases of superficial infection, qualified for data extraction. A wide range of treatment modalities were identified in different compositions. The four most represented were 1) antibiotics (92.5%), 2) Irrigation and debridement (82.2%), 3) hardware removal (59.6%), and 4) negative pressure wound therapy (26.7%). Other treatment modalities include soft-tissue reconstruction, immobilisation, platelet-rich plasma and urinary bladder matrix. CONCLUSION: There is a paucity of literature on the diagnosis and treatment of superficial infections following ankle fracture surgery. Limited low-quality evidence suggests a combination of irrigation and debridement, antibiotics and frequent hardware removal, with the occasional use of negative pressure wound therapy. Further research is warranted before consensus can be reached on treatment guidelines.