scholarly journals Syndesmosis Injuries in Ankle Fractures: Correlation of Fracture Type and Syndesmotic Instability

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0021
Author(s):  
Christina Freibott ◽  
Seth C. Shoap ◽  
Sebastian F. Baumbach ◽  
Kathrin Rellensmann ◽  
Rami Alrabaa ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Ankle Fracture ◽  
Ankle Fractures ◽  
Fracture Type ◽  
Syndesmotic Injury ◽  
Type B ◽  
Chi Square ◽  
Ao Classification ◽  
Fibula Fracture ◽  
Chi Square Analysis

Category: Ankle; Trauma Introduction/Purpose: Ankle fractures are among the most common injuries treated by orthopedic surgeons. Syndesmotic disruption in ankle fractures can be identified preoperatively, however the decision to fix the syndesmosis is made after this intraoperative assessment. The AO classification groups ankle or malleolar fractures into A (infrasyndesmotic fibula fracture), B (transsyndesmotic fibula fracture), and C (suprasyndesmotic fibula fracture) with succeeding digits that further classify each fracture group in more detail. This study aimed to retrospectively review databases of ankle fractures across two major academic centers to determine the rate of syndesmotic injury and to assess the association between ankle fracture type (utilizing the AO classification) and presence of syndesmotic injury. Methods: Patients 18 years or older who were treated surgically for an ankle fracture at two major academic institutions between 2010 and 2016 were selected for review. Exclusion criteria were open fractures, pilon fractures, tibial shaft fractures, or patients who underwent open reduction and internal fixation of an ankle fracture involving the posterior malleolus. The preoperative injury films of each ankle fracture was reviewed and classified according to the AO classification. The postoperative films were then reviewed for each case to classify the fractures into stable or unstable syndesmosis based on whether syndesmotic fixation was performed. Stability of the syndesmosis was tested intraoperatively after internal fixation of the fracture fragments using the Cotton test and external rotation stress views. Fixation of the syndesmosis was performed with either a syndesmotic screw or suture button fixation per surgeon preference. Chi-square analysis was used to assess the association between fracture types and syndesmotic injury. Results: 733 patients met inclusion criteria. Average patient age was 54.22 with 52.8% being female. 273 patients had sustained a syndesmotic injury (Figure 1). Association between fracture type (AO classification) and syndesmotic injury was assessed with chi- square analysis showing significant association (X28=193.842, p<0.001). Type B fractures in this study were further classified with AO classification (9 subcategories) to assess for an association with syndesmotic injury within a subcategory of these fractures (Figure 1). Chi-square analysis of type B fracture subgroups revealed significant association between fracture subgroup and syndesmotic disruption (X28=76.379, p<0.001). There was a statistically significant association between single digit AO classification and syndesmotic injury (X28=193.842, p<0.001) as well as the two-digit AO classification for type B fractures and syndesmotic injury (X28=76.379, p<0.001). Conclusion: This study aimed to identify ankle fracture patterns that are prone to syndesmotic injury. Identifying fractures preoperatively that are likely to have syndesmotic injury is beneficial to surgeon and patient as it aids in operative planning, intraoperative equipment needs, managing patient expectations, and counselling patients preoperatively about changes in rehabilitation protocols with injuries that involve the syndesmosis. Most of the type C fractures (88.50%) had syndesmotic injury, 7.14% of type A fractures involved the syndesmosis, and type B fractures had variable syndesmotic involvement (31.15%). Chi- square analysis revealed that significant association exists between type B2 and syndesmotic injury (X28=76.379, p<0.001).

scholarly journals Associations of overweight, obesity and osteoporosis with ankle fractures

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Anja M. Hjelle ◽  
Ellen M. Apalset ◽  
Jan-Erik Gjertsen ◽  
Roy M. Nilsen ◽  
Anja Lober ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Mineral Density ◽  
Body Mass Index ◽  
Bone Mineral ◽  
Ankle Fracture ◽  
Type A ◽  
Ankle Fractures ◽  
Fracture Type ◽  
Type B ◽  
Mineral Density

Abstract Background Studies exploring risk factors for ankle fractures in adults are scarce, and with diverging conclusions. This study aims to investigate whether overweight, obesity and osteoporosis may be identified as risk factors for ankle fractures and ankle fracture subgroups according to the Danis-Weber (D-W) classification. Methods 108 patients ≥40 years with fracture of the lateral malleolus were included. Controls were 199 persons without a previous fracture history. Bone mineral density of the hips and spine was measured by dual-energy x-ray absorptiometry, and history of previous fracture, comorbidities, medication, physical activity, smoking habits, body mass index and nutritional factors were registered. Results Higher body mass index with increments of 5 gave an adjusted odds ratio (OR) of 1.30 (95% confidence interval (CI) 1.03–1.64) for ankle fracture, and an adjusted OR of 1.96 (CI 0.99–4.41) for sustaining a D-W type B or C fracture compared to type A. Compared to patients with normal bone mineral density, the odds of ankle fracture in patients with osteoporosis was 1.53, but the 95% CI was wide (0.79–2.98). Patients with osteoporosis had reduced odds of sustaining a D-W fracture type B or C compared to type A (OR 0.18, CI 0.03–0.83). Conclusions Overweight increased the odds of ankle fractures and the odds of sustaining an ankle fracture with possible syndesmosis disruption and instability (D-W fracture type B or C) compared to the stable and more distal fibula fracture (D-W type A). Osteoporosis did not significantly increase the odds of ankle fractures, thus suffering an ankle fracture does not automatically warrant further osteoporosis assessment.

scholarly journals Arthroscopic Findings During Routine Ankle ORIF: What is Being Missed?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0026
Author(s):  
Shain Howard ◽  
Victor C. Hoang ◽  
Troy S. Watson ◽  
Candice L. Brady ◽  
Adam Eudy
Keyword(s):  
Fracture Fixation ◽  
Ankle Fracture ◽  
External Rotation ◽  
Ankle Arthroscopy ◽  
Ankle Fractures ◽  
Osteochondral Lesions ◽  
Fracture Type ◽  
Syndesmotic Injury ◽  
Patient Reported ◽  
Articular Pathology

Category: Ankle; Arthroscopy; Trauma Introduction/Purpose: Ankle fractures are among the most common operatively treated injuries by orthopedic surgeons. However, up to 20% of patients will have continued pain and poor patient reported outcomes despite good/excellent radiographic results. Ankle fractures typically occur with varying degrees of intra-articular and soft tissue injury which can include ligamentous injury, loose bodies, and chondral lesions. The aim of study is to document intra-articular findings with ankle arthroscopy prior to ankle open reduction internal fixation (ORIF) and to contribute to the growing body of literature that shows this to be a safe adjunct to fracture fixation. Methods: IRB approval was obtained prior to chart review. This is a retrospective review of ankle fractures that were treated with arthroscopy and ORIF by a single surgeon. Between August 2016 and July 2018 Operative reports, office notes, and images were reviewed to identify intra-articular pathology and fracture type. Analysis was performed with regard to fracture type, presence and location of osteochondral lesions, presence of loose-body, syndesmotic injury, and deltoid injury. Results: Fifty-seven ankle fractures were identified that met inclusion criteria. 84.2% of the fractures had intra-articular pathology, most commonly a syndesmotic injury followed by loose joint body and osteochondral defect. Conclusion: Arthroscopic evaluation during ankle fracture ORIF, particularly pronation external rotation and supination external rotation patterns give a more detailed examination of associated pathology. Arthroscopy at the time of ankle fracture fixation is a safe adjunct and should be considered a potential compliment to routine ORIF of ankle fractures.

Predictors of Time to Union After Operative Fixation of Closed Ankle Fractures

2016 ◽  
Vol 10 (4) ◽  
pp. 308-314 ◽  
Author(s):  
Andrew P. Matson ◽  
Kamran S. Hamid ◽  
Samuel B. Adams
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Case Series ◽  
Patient Characteristics ◽  
High Energy ◽  
Delayed Union ◽  
Ankle Fractures ◽  
Patient Counseling ◽  
Chi Square ◽  
Energy Mechanism

Background. Ankle fractures are common and represent a significant burden to society. We aim to report the rate of union as determined by clinical and radiographic data, and to identify factors that predict time to union. Methods. A cohort of 112 consecutive patients with isolated, closed, operative malleolar ankle fractures treated with open reduction and internal fixation was retrospectively reviewed for time to clinical union. Clinical union was defined based on radiographic and clinical parameters, and delayed union was defined by time to union >12 weeks. Injury characteristics, patient factors and treatment variables were recorded, and statistical techniques employed included the Chi-square test, the Student’s T-test, and multivariate linear regression modeling. Results. Forty-two (37.5%) of patients who achieved union did so in less than 12 weeks, and 69 (61.6%) of these patients demonstrated delayed union at a mean of 16.7 weeks (range, 12.1-26.7 weeks), and the remaining patient required revision surgery. Factors associated with higher rates of delayed union or increased time to union included tobacco use, bimalleolar fixation, and high energy mechanism (all p<0.05). In regression analysis, statistically significant negative predictors of time to union were BMI, dislocation of the tibiotalar joint, external fixation for initial stabilization and delay of definitive management (all p<0.05). Conclusion. Patient characteristics, injury factors and treatment variables are predictive of time to union following open reduction and internal fixation of closed ankle fractures. These findings should assist with patient counseling, and help guide the provider when considering adjunctive therapies that promote bone healing. Levels of Evidence: Prognostic, Level IV: Case series

scholarly journals Immediate Weight Bearing and Range of Motion After Internal Fixation of Unstable Ankle Fractures: A Retrospective Controlled Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0021
Author(s):  
Brianna R. Fram ◽  
Ryan G. Rogero ◽  
Daniel Corr ◽  
Gerard Chang ◽  
James Krieg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Internal Fixation ◽  
Range Of Motion ◽  
Ankle Fracture ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Controlled Study ◽  
Posterior Malleolus ◽  
Significant Difference ◽  
Operative Complications

Category: Ankle; Trauma Introduction/Purpose: Ankle fractures are the third most common adult fractures. Further, they are the second most common fracture type to require inpatient admission, behind only hip fractures, despite occurring in a population on average nearly 30 years younger. There is evidence that early or immediate weight bearing and range of motion may be safe following ankle fracture fixation, but existing studies are small and largely exclude patients with syndesmotic or posterior malleolar fixation. We therefore studied the safety of immediate weight bearing as tolerated (IWBAT) and immediate range of motion (IROM) following open reduction internal fixation (ORIF) of unstable ankle fractures in a diverse cohort and attempted to identify risk factors for complications. Methods: We performed a retrospective case-control study. Out of 268 patients who underwent primary ORIF of an unstable ankle fracture from 2013-18, we identified 133 (49.6%) who were IWBAT and IROM. The treating surgeon excluded patients from IWBAT if they had an ipsilateral leg injury requiring non-weight bearing, a large displaced posterior malleolus fragment, or Maisonneuve injury with fracture of the proximal fibula. We used propensity-score matching to identify 172 controls who were non-weight bearing (NWB) and no range of motion for 6 weeks post-op. We reviewed medical records and radiographs for demographic, injury and treatment characteristics. Our primary outcome was complications. We compared demographics, injury characteristics, treatment episode, and complications between the IWBAT and NWB groups and performed within group analysis to identify risk factors for complications. A p-value <0.05 was considered significant. Results: The groups did not differ significantly in age, BMI, Charleston Comorbidity Index (CCI), smoking status, diabetes status, malleoli involved, percentages undergoing medial malleolus (60.9% IWBAT vs. 51.7% NWB, p=0.11), posterior malleolus (24.1% IWBAT, 26.7% NWB, p=0.59), or syndesmosis fixation (41.4% IWBAT, 42.4% NWB, p=0.85). There was no significant difference in total complications (9.8% IWBAT vs. 12.8% NWB, p=0.41), nonoperative complications (6.8% IWBAT vs. 8.7% NWB, p=0.53), or operative complications (3.8% IWBAT vs. 4.1% NWB, p=0.89). We did not identify any factors associated with increased complication risk, including posterior malleolus or syndesmosis fixation, diabetes, age, CCI or pre-injury assisted ambulation. Conclusion: IWBAT and IROM may be safe following ankle fracture ORIF in a broader patient population than previously believed. We did not identify specific risk factors for post-operative complications. Further study on patient selection may allow for more extensive use of this protocol to reduce the morbidity associated with unstable ankle fractures. [Table: see text]

scholarly journals The Assessment of Reduction Status Using Radiographic Parameters and Ideal Trans-Fixation Technique for Unstable Syndesmotic Injury with Ankle Fracture

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0033
Author(s):  
Chul-Hyun Park ◽  
Kwang-Soon Song ◽  
Beom-Soo Kim ◽  
Jung-Hoon Choi ◽  
Hyuk-Jun Kwon ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Mean Value ◽  
Ankle Fractures ◽  
Ct Scans ◽  
Syndesmotic Injury ◽  
Fixation Technique ◽  
Perpendicular Line ◽  
Group A ◽  
The Mean ◽  
The Absolute

Category: Ankle, Trauma Introduction/Purpose: Anatomical restoration of distal tibiofibular syndesmosis is essential in ankle fractures with syndesmotic injury. However, intraoperative reference line of penetrating angle and evaluation of reduction status remains without consensus. The purpose of this study is to analyze the reduction status of syndesmotic injury using radiographic parameters and to find ideal fixation angle treated with trans-fixation in unstable syndesmotic injury. Methods: Twenty-six patients with ankle fractures with syndesmotic injury that underwent preoperative and postoperative bilateral computed tomography (CT) scans were enrolled. A multi-center study was performed in two tertiary medical centers. All patients were treated with tibiofibular trans-fixation screw or tight rope® fixation. The axial sections of bilateral CT scans were reviewed to measure Fibular Diastasis (FD) and Surface Area of Syndesmosis (SAS) at the level of 1.0 cm above ankle joint. Reduction status was measured by calculating the ratio of postoperative and intact side using radiologic parameters. The trans-fixation angles between the perpendicular line of incisura and distal trans-fixation material was measured. Patients were classified by trans-fixation angle into three groups, as showing 0 -1 degree (A), 1-5 degree (B), 5 or more degree (C) in absolute value. Results: The mean value of reduction status ratio was 1.13 in FD and 1.27 in SAS. The absolute mean value of trans-fixation angle was 4.11°. Trans-fixation angle and reduction status had positive correlation in FD (R = 0.522, p = 0.006) and SAS ratio (R = 0.695, p = 0.000). The absolute mean value of trans-fixation angle in group A, B, C was 0.56° (7 cases), 3.01° (12 cases), and 8.90° (7 cases). The mean value of FD ratio in group A, B, C was 1.01, 1.03 and 1.41. FD and SAS ratio had no difference between group A and B but had significant difference between group A, B and C (p < 0.05). Conclusion: Inappropriate trans-fixation technique had correlated with the loss of reduction after treatment of unstable ankle fracture associated with syndesmotic injury. An angle of 5° from the perpendicular line of the incisura is considered as the ideal trans-fixation angle to maintain the reduction status.

scholarly journals Role of Arthroscopy in Ankle Fracture Surgery

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0045
Author(s):  
Jae Hoon Ahn
Keyword(s):  
Internal Fixation ◽  
Ankle Fracture ◽  
Postoperative Outcome ◽  
Persistent Pain ◽  
Ankle Arthroscopy ◽  
Ankle Fractures ◽  
Definitive Treatment ◽  
Syndesmosis Injury ◽  
Poor Outcomes

The ankle arthroscopy is widely used as an essential tool for the various ankle disorders. The use of arthroscopy has also been tried for the treatment of acute ankle fractures, in the hope of improving the postoperative outcome. It was initially thought that the properly reduced ankle fractures had generally acceptable outcomes, with a reported rate of 81% good to excellent results. However further investigation and longer term follow-up has shown more mixed and less encouraging results. Some patients have persistent pain and poor outcomes following open reduction and internal fixation (ORIF), although the cause of poor outcome is not clearly understood. It may be secondary to intra-articular injuries at the time of fracture, which occur in up to 88% of fractures. Ankle arthroscopy at the time of ORIF has been proposed to address these intraarticular injuries. Arthroscopy-assisted reduction and percutaneous screw fixation for syndesmosis injury has been performed as well by some surgeons. However the effectiveness of true arthroscopic reduction and internal fixation compared with ORIF for ankle fractures has yet to be determined, in spite of the advantages such as limited exposure, preservation of blood supply, and improved visualization of the pathology. Postoperative chronic pain and arthrofibrosis after ankle fracture are another good indication for ankle arthroscopy, which can be performed at the time of implant removal. In conclusion, the ankle arthroscopy is a safe adjunctive procedure for the treatment of ankle fractures. It can be performed as well for the evaluation and management of syndesmotic injury, and for persistent pain following the definitive treatment of ankle fractures.

scholarly journals Early weight bearing compared with non-weight bearing functional mobilization after operative treatment of an ankle fracture

2012 ◽  
Vol 7 (1) ◽  
pp. 40-46
Author(s):  
KP Paudel
Keyword(s):  
Internal Fixation ◽  
Operative Treatment ◽  
Ankle Fracture ◽  
Subjective Evaluation ◽  
Weight Bearing ◽  
Randomized Study ◽  
T Test ◽  
Ankle Fractures ◽  
Early Weight Bearing

Ankle fractures are the most common types of fractures treated in orthopaedics. When to begin ankle movement and weight bearing and the type of immobilizing devices to use post-operatively have had more intense clinical study than most other aspects of ankle fracture treatment. Aim of this study is to compare the results of two functional methods of post-operative treatment in internally fixed ankle fractures, i.e. one after early weight bearing using walking plaster and the other after non-weight bearing functional mobilization in the first six weeks following stable internal fixation. This is a prospective, non-randomized study. Between March 2004 and February 2006, thirty- five patients with displaced ankle fractures treated by internal fixation were assigned in a way that every alternate patient fell in different groups. Group A patients, 17, were managed with a below-knee walking plaster and group B patients, 18 with non-weight bearing mobilization with crutches. Five patients were lost in follow up and 30 were followed regularly as in the protocol. There was a temporary benefit in subjective evaluation (63 v 48 points, student t test. P=0.262), return to work (53.8 v 72.9 days, student t test, p=0.079) for those with a below-knee walking plaster at six week. There were minimal differences between the groups in the loss of dorsal range of movement (14.7 v 13.1 degree) or in the overall clinical results at the first follow up. But the differences disappeared in any evaluation after three months. Both treatments were considered to be satisfactory and the treatment choice depends on the ability to mobilize or weight bearing, the type of work and personal preference. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5972 JCMSN 2011; 7(1): 40-46

scholarly journals Increased Rates of Readmission, Reoperation, and Mortality Following Open Reduction and Internal Fixation of Ankle Fractures Are Associated with Diabetes Mellitus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0032
Author(s):  
Jennifer Liu ◽  
Junho Ahn ◽  
Dane Wukich ◽  
Katherine Raspovic
Keyword(s):  
Diabetes Mellitus ◽  
Internal Fixation ◽  
Ankle Fracture ◽  
Open Reduction ◽  
Large Scale ◽  
Ankle Fractures ◽  
Unplanned Readmission ◽  
Diabetic Patients ◽  
Acs Nsqip ◽  
Increased Risk

Category: Ankle Introduction/Purpose: Ankle fractures are amongst the most common type of fracture injury in adults with an annual incidence of 187 fractures per 100,000 people in the United States. Previous groups have shown that diabetes mellitus (DM) is associated with a myriad of complications – including infection, malunion, and impaired wound healing – following open reduction internal fixation (ORIF) surgery for ankle fractures. However, to our knowledge there has not been a large-scale nationwide study on the rate of readmission, reoperation, and mortality associated with DM. The purpose of this study was to calculate the increased risk and odds ratios for 30-day postoperative readmission, reoperation, and mortality after ankle fracture ORIF. Methods: Patients who underwent ORIF for ankle fractures from 2006 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database using Current Procedural Terminology codes. Median values along with 25th to 75th interquartile ranges (IQRs) were used to describe continuous variables and frequency (%) was used to describe categorical variables. Patient demographic factors along with 30-day postoperative outcomes were compared between those who had DM and those who did not have DM using the Mann-Whitney test or?2 test. 30-day postoperative unplanned readmission, unplanned reoperation, and mortality rates were compared in 2,044 patients with DM and 15,420 patients without DM. Crude odds ratios (OR) and adjusted ORs controlling for age differences were calculated for each parameter with a 95% confidence interval (CI). All statistical analyses were performed with a significance level of 0.05. Results: Patient factors and pre-operative laboratory statistics are summarized in Figure 1D, and the distribution of ankle fractures types are shown in Figure1A&B. Comparing patients with DM vs without DM, the rate of readmission was 4.35% vs 1.50%, rate of reoperation was 2.30% vs 0.75%, and rate of mortality was 0.73% vs 0.21%. As shown in Figure 1C, we found that patients with DM had a 2.66 times increased risk of readmission (CI: 1.99-3.52, p = 0.0001), 2.76 increased risk of reoperation (CI: 1.91-3.92, p = 0.0001), and a 2.34 increased risk of mortality (CI: 1.19-4.44, p = 0.0377). Interestingly, we also found a 22.06 increased risk of amputation (CI: 3.29-344.8, p = 0.0063) though the rate of amputation in both groups was very small. Conclusion: In this large-scale retrospective study we showed that the presence of diabetes mellitus significantly increases the risk of unplanned readmission, unplanned reoperation, and mortality within 30 days after ankle fracture ORIF surgery. Thus, patients with diabetes that require ORIF ankle surgery should be informed of their increased risk of complications and extra precautions should be taken to minimize risk. Further research in optimization of perioperative care for diabetic patients is crucial to reducing rates of complication. Large clinical databases such as ACS-NSQIP should endeavor to collect more parameters on diabetic patients to facilitate these studies.

Association of Bleeding Disorders and Risk of Complications Following Open Reduction and Internal Fixation of the Ankle

2021 ◽  
pp. 107110072110581
Author(s):  
Alisa Malyavko ◽  
Theodore Quan ◽  
William T. Stoll ◽  
Joseph E. Manzi ◽  
Alex Gu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Internal Fixation ◽  
Operative Treatment ◽  
Ankle Fracture ◽  
Open Reduction ◽  
Bleeding Disorder ◽  
Ankle Fractures ◽  
Bleeding Disorders ◽  
Increased Risk

Background: Open reduction and internal fixation (ORIF) of the ankle is a common procedure performed to correct ankle fractures in many different patient populations. Diabetes, peripheral vascular disease, and osteoporosis have been identified as risk factors for postoperative complications following surgery for ankle fractures. To date, there have not been any studies evaluating postoperative outcomes in patients with bleeding disorders undergoing operative treatment for ankle fractures. The aim of this study was to determine the postoperative complication rate following ORIF of the ankle in patients with a bleeding disorder vs those without a bleeding disorder. Methods: From 2006 to 2018, patients undergoing operative treatment for ankle fracture were identified in the National Surgical Quality Improvement Program database. Two patient cohorts were defined: patients with a bleeding disorder and patients without a bleeding disorder. Patients who underwent either inpatient or outpatient ORIF of the ankle were included in this study. In this analysis, demographics, medical comorbidities, and postoperative complications variables were assessed between the 2 cohorts. Bivariate and multivariate analyses were performed. Results: Of 10 306 patients undergoing operative treatment for ankle fracture, 9909 patients (96.1%) had no bleeding disorder whereas 397 patients (3.9%) had a bleeding disorder. Following adjustment on multivariate analysis, compared to patients who did not have a bleeding disorder, those with a bleeding disorder had an increased risk of any postoperative complications (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.05-2.08, P = .024), requirement for postoperative blood transfusion (OR 2.86, 95% CI 1.53-5.36, P = .001), and extended length of hospital stay greater than 5 days (OR 1.46, 95% CI 1.10-1.93, P = .010). Conclusion: Patients with bleeding disorders are associated with increased risk of postoperative complications following ORIF for ankle fractures. Determining patient risk factors and creating optimal preoperative and perioperative management plans in patients with bleeding disorders undergoing ORIF can be beneficial in reducing postoperative complications, improving patient outcomes, and reducing overall morbidity. Level of Evidence: Level III, retrospective cohort study.

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