Objective To explore the main risk factors for incisional infection after ankle fracture surgery. Methods Literatures in China National Knowledge Infrastructure (CNKI), Wanfang, VIP, PubMed, Embase, Web of Science, and Cochrane Library from the establishment of the database to June 2021 were searched by computer.After two reviewers independently screened the literatures, extracted the data and evaluated the quality according to the inclusion and exclusion criteria, Meta-analysis was performed with Rev Man 5.3 and STATA 12.0 software. Results 12 literatures were included for analysis, involving10 037 patients, including 560 cases of incisional infection, incidence of incisional infection was 5.58%.Meta-analysis results showed that the main risk factors for incisional infection after ankle fracture surgery included: age (MD=4.70, 95%CI: 3.05-6.34), body mass index (MD=0.82, 95%CI: 0.36-1.29), preoperative albumin < 35 g/L (OR=2.30, 95%CI: 1.26-4.22), combined with diabetes (OR=1.71, 95%CI: 1.26-2.30), combined with heart disease (OR=2.92, 95%CI: 1.74-4.91), smoking (OR=1.51, 95%CI: 1.05-2.16), drinking (OR=1.56, 95%CI: 1.19-2.05), open fracture (OR=5.59, 95%CI: 4.05-7.73), combined with fracture dislocation (OR=1.72, 95%CI: 1.35-2.18), duration of surgery (MD=24.56, 95%CI: 17.59-31.53), American Society of Anesthesiologists (ASA) grade ≥3(OR=2.05, 95%CI: 1.51-2.78), and grade Ⅱ-Ⅳ contaminated incision (OR=4.66, 95%CI: 2.93-7.43). Conclusion There are multiple risk factors for incisional infection after ankle fracture surgery, health care workers should pay attention to the main risk factors for incisional infection after ankle fracture surgery and take targeted measures to reduce incisional infection rate.