Introduction Ankle fractures are increasingly common in older adults, with complication rates of up to 30% following surgical treatment. Identifying risk factors for fracture-related infections (FRI) could enable surgeons to reduce the complication rate. Methods In this retrospective case-control study, we screened 950 patient records and documented 59 patients aged 50 years and older with an FRI in the first 3 months after operative treatment of an ankle fracture. Cases of FRI were matched with controls without FRI based on age and sex. Results The risk factor analyses identified hypoalbuminemia (OR=17,7), non-compliance (OR=5,1), chronic alcohol abuse (OR=5,5), and high-impact trauma (OR=5,1) as patient-related risk factors. Larger blood loss during surgery, malreduction, and difficulties during surgery were identified as modifiable risk factors associated with operative skill level Discussion Early FRI occurred in 6.2% of patients, aligning with reported rates in the literature. The study highlights several modifiable factors associated with increased infection risk, including hypoalbuminemia, substance abuse, postoperative non-compliance, and surgical issues such as malreduction and intraoperative difficulties. High-energy trauma was also strongly associated with infection. Open fractures showed a non-significant trend toward higher risk, likely reflecting limited sample size and optimized management protocols. Overall, the findings underscore the importance of addressing patient-related vulnerabilities and ensuring high surgical quality to reduce infection risk in older adults undergoing ankle fracture fixation. Conclusion This study highlights the importance of careful patient selection, optimization of modifiable risk factors, and surgical expertise to improve outcomes for patients undergoing ankle fracture fixation.
Najjar et al. (2026) studied this question.