Abstract
Background: The optimal timing of surgical treatment for ankle fractures remains a topic that is associated with clinical uncertainty. While delayed surgery is often necessary for safe wound closure, prolonged immobilization, impaired functional outcomes, protracted hospitalization, and an increased risk of infection are potential disadvantages. This study was aimed at investigating the interval between trauma, surgical fixation, and postoperative infections among patients with closed ankle fractures. Methods: We conducted a retrospective cohort study involving 224 patients treated surgically for fractures of the upper ankle joint between January 2020 and December 2023. The patients were stratified into two groups based on surgical timing: within 24 h of hospital admission (early surgery) or after 24 h (delayed surgery). The primary outcome was the incidence of postoperative infections. A multivariate logistic regression model was constructed to assess independent risk factors. Results: Of the 224 patients, 30 (13.4%) developed postoperative infections. Infection occurred in 11.1% of patients who underwent early surgery and 13.7% of those subjected to delayed surgery. This difference was not statistically significant in the unadjusted analysis (p = 0.747). However, an additional day of surgical delay was associated with an 11% increase in the odds of postoperative infection (OR = 1.11; 95% CI: 1.01-1.22; p = 0.034). Female patients had over threefold higher odds of infection than males (OR = 3.20; 95% CI: 1.32-8.09; p = 0.011), and diabetes was a significant risk factor, with diabetic individuals showing more than fivefold increased odds (OR = 5.56; 95% CI: 1.30-25.00; p = 0.019). Patients with delayed surgery had significantly longer hospital stays (+2.83 days, p < 0.05). Conclusions: Early surgical intervention appears to lower the risk of postoperative infections, is associated with hospitalization duration, and should be considered when clinically appropriate.