Injury, Int. J. Care Injured 34 (2003) 928–931 Soft tissue problems in ankle fractures treated surgically A prospective study of 154 consecutive closed ankle fractures P. Höiness a,* , L. Engebretsen a , K. Strömsöe b a Oslo Orthopaedic University Clinic, Ullevaal Hospital, N-0407 Oslo, Norway b Aker University Hospital, Trondheimsveien 235, N-0541 Oslo, Norway Accepted 7 February 2002 Abstract We performed a prospective registration of primary soft tissue injuries and perioperative soft tissue complications the first 3 months after surgery in ankle fractures treated by open reduction and internal fixation. Open fractures and polytraumatized patients were excluded. The 154 consecutive patients (90 women) with an average age of 54.5 (S.D. 18.3) years were registered. Primary soft tissue injuries according to Tscherne’s classification were noted in 22 patients (14.2%). Major perioperative soft tissue complications requiring revision occurred in five patients (3.2%). Minor perioperative soft tissue complications treated non-operatively occurred in 29 patients (18.8%). A significantly higher incidence of perioperative soft tissue complications occurred in alcohol abusers (P = 0.043), after high-energy trauma (P = 0.043), and after primary soft tissue injuries (P = 0.004). Other possible risk factors such as age, gender, fracture type, diabetes, arteriosclerosis, coronary heart disease, and hypothyroidism had no statistically significant influence on the incidence of perioperative soft tissue complications. © 2002 Elsevier Science Ltd. All rights reserved. 1. Introduction The incidences of primary soft tissue injuries and pe- rioperative soft tissue complications in ankle fractures are poorly documented. The management of typical soft tissue problems such as extensive swelling, bruises and fracture blisters, is an issue of debate in orthopaedic de- partments, particularly related to the timing of surgery. No previous study has demonstrated the relationship be- tween the primary soft tissue injuries and the severity of the bony injury in ankle fractures, whereas such a relation- ship was found in an investigation on humerus fractures [1]. A retrospective investigation of surgically treated ankle fractures demonstrated a higher short-term incidence of soft tissue complications in the perioperative course of the AO types B2 and B3 fractures compared to other types of fractures [2]. The results of this study supported the view that ankle injuries at the level of the syndesmosis are less stable and that perioperative soft tissue complications such as infections and necrosis may occur [3]. It is also rea- sonable to believe that other concomitant diseases such as * Corresponding author. Tel.: +47-221-19500; fax: +47-221-19558. E-mail address: p.r.hoiness@medisin.uio.no (P. Höiness). arteriosclerosis and diabetes, smoking and age predispose to a higher incidence of soft tissue problems. The aim of the study was to investigate the incidence of soft tissue problems and their possible risk factors within the first 3 months after the injury in the operative treatment of closed ankle fractures. 2. Patients All patients (n = 202) admitted to our hospital with an acute ankle fracture from 1 May 1998 to 31 December 1999 were prospectively registered. Forty-six patients were ex- cluded due to open fractures (n = 5), non-operative treat- ment (n = 32), polytrauma (n = 6) or external fixation (n = 3). Two patients were excluded due to short obser- vation time; one patient died of unrelated reasons and one patient emigrated. Complete data sets were obtained in the remaining 154 patients (90 women) available for clinical evaluation. The average age of the included patients was 49.8 (S.D. 18.2, range 16–85) years. The female patients (54.5 years, S.D. 18.3) were significantly older than the male patients (43.2 years, S.D. 16.1) (P< 0.001, CI 5.8–16.8, indepen- dent samples t-test). The average height and weight of the 0020-1383/$ – see front matter © 2002 Elsevier Science Ltd. All rights reserved. PII:S0020-1383(02)00309-1