Calcification on X-rays Predicts Ankle Surgery Complications

A simple look at the preoperative X-ray can flag which ankle fracture patients are headed for serious trouble – before the first incision. It seems obvious, but having a visual trigger for additional testing and discussion with patients is key. 

The big picture

According to a March 2026 study, patients with peripheral arterial calcifications (PACs) visible on injury X-rays, fa ed significantly higher rates of wound complications and return trips to the OR after ankle open reduction internal fixation.

The numbers

• One in three PAC patients (33.3%) developed wound complications.

• One in five patients (21.2%) required reoperation for debridement.

• PACs were present in 9% of all operative ankle fractures.

Clinical takeaway

PACs on a plain X-rays offer a simple, cost-free way to identify high-risk patients. Surgeons should flag these patients early for multidisciplinary perioperative planning and detailed risk discussions with patients.