Risk factors for post-traumatic lymphedema after open fractures of the lower leg: a retrospective cohort study.

BACKGROUND: Post-traumatic lymphedema (PTL) is an underrecognized complication of severe limb trauma and is characterized by persistent limb swelling. Patients with open fractures of the lower leg may be more susceptible to PTL, and clinical factors such as extensive soft-tissue injury, wound infection, and repeated surgical procedures may be associated with lymphatic injury and local inflammation. However, the clinical factors associated with PTL in this population remain unclear. This study aimed to identify factors associated with PTL after open fractures of the lower leg. METHODS: We retrospectively screened 129 patients treated for open fractures of the lower leg between March 2023 and March 2025. After excluding one patient who underwent amputation and seven who were lost to follow-up, 121 patients were included and assessed for post-traumatic lymphedema at 6 months after the initial operation. Binary logistic regression was used to identify associated factors. RESULTS: Of the 121 patients, 41 (33.88%) developed PTL. Multivariable logistic regression showed that increasing age (odds ratio [OR] = 1.05, 95% confidence interval [CI] 1.02-1.09; P = 0.002), postoperative infection (OR = 5.15, 95% CI 1.25-21.19; P = 0.023), and skin and soft-tissue necrosis-related defects (OR = 5.76, 95% CI 2.04-16.31; P < 0.001) were associated with PTL. Diabetes mellitus did not reach statistical significance, although the point estimate was elevated (OR = 8.00, 95% CI 0.77-82.97; P = 0.081). In the extended sensitivity model, increasing age and postoperative infection remained associated with PTL, whereas the associations of the two injury-severity indicators were attenuated. In the alternative injury-severity model, Gustilo-Anderson type IIIB/IIIC injury was associated with PTL. CONCLUSIONS: Increasing age and postoperative infection were consistently associated with PTL after open fractures of the lower leg. Skin and soft-tissue necrosis-related defects and Gustilo-Anderson type IIIB/IIIC injuries showed model-dependent associations. These findings may support targeted postoperative surveillance.