New Study Identifies Key Warning Signs for Infection After Ankle Fracture Surgery in Older Patients
Article by Dr. Molham Najjar; Department of Orthopaedics and Traumatology, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031 Basel, Switzerland; E-mail: dr.molham.najjar@gmail.com
Why This Research Was Needed
Ankle fractures are becoming more common among older adults, and surgery to fix them carries a complication rate of up to 30%. One of the most serious complications is a fracture-related infection (FRI) — an infection that develops at or around the fracture site following surgery — which almost always requires a second operation. Despite this, little was known about which patients are most at risk, especially those aged 50 and older. A research team led by Dr. Molham Najjar, from the Department of Orthopaedics and Traumatology at University Hospital Basel, University of Basel, Switzerland, and the Department of Orthopaedics and Trauma Surgery at Hirslanden Klinik Birshof, Basel, Switzerland, set out to change that.
What the Researchers Did and Found
The team reviewed the medical records of 950 patients aged 50 or older who had ankle fracture surgery at University Hospital Basel between 2008 and 2017. Of these, 59 patients (6.2%) developed a confirmed infection within three months of their operation, and every one of them required revision surgery. These 59 patients were carefully matched with 59 patients who had no infection, and the two groups were compared to identify what set the infected group apart. The results were striking. Low protein levels in the blood — a condition called hypoalbuminemia — emerged as the single strongest patient-related risk factor, making infection nearly 18 times more likely. Chronic alcohol abuse and failure to follow post-operative instructions (such as keeping weight off the ankle) each raised the risk more than fivefold. Sustaining the original fracture through a high-energy incident, such as a traffic accident rather than a simple fall, was also associated with five times the infection risk. On the surgical side, cases where the broken bone was not adequately realigned carried an odds ratio of over 22, while operations that ran into technical difficulties were nearly four times more likely to result in infection.
What This Means for Patients and Surgeons
The findings carry a clear practical message: a significant number of the factors that lead to infection after ankle fracture surgery can be identified — and some addressed — before a patient goes to the operating theatre. Checking and correcting low albumin levels, counselling patients on alcohol use, and setting clear expectations about post-operative compliance could all reduce the chance of a devastating complication. The study also reinforces that ankle fracture surgery, though it may appear routine, demands a high level of surgical skill. The authors note that in one published series where all operations were performed by a single experienced surgeon, the infection rate fell below 3% — far lower than most reported figures, including those in the present study. The research was exploratory in nature and the authors call for larger, prospective studies to confirm these findings, but the message for clinical teams caring for older patients with ankle fractures is already clear: know your patient's risk profile, optimise what you can before surgery, and ensure the operation is performed to the highest possible standard.
About the Study Najjar M, Morgenstern M, Halbeisen F, Eckardt H. Risk Factors for Early Fracture-related Infection After Surgical Treatment of Ankle Fractures in Patients Aged 50 Years and Older. Open Orthop J, 2026; 20: e18743250464468.
Read the published article here: https://bit.ly/4fEKHtV
The Open Orthopaedics Journal
DOI: 10.2174/0118743250464468260318132933
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The Open Orthopaedics Journal
10.2174/0118743250464468260318132933
New Study Identifies Key Warning Signs for Infection After Ankle Fracture Surgery in Older Patients