Abstract: OBJECTIVE To explore the main risk factors for surgical site infection (SSI) after lower extremity long bone fracture surgery in Chinese patients through meta-analysis. METHODS Computerized searches were conducted in CNKI, WanFangData, VIP, PubMed, Cochrane Library and Web of Science databases to collect relevant literature from their inception to Mar. 2025. Two researchers independently performed literature screening, data extraction, cross-checking and quality assessment. Stata 17.0 software was used for meta-analysis. RESULTS A total of 24 studies involving 11 209 patients were included, with 523 cases suffering from SSI and a coinfection incidence rate of 4.89%. A total of 18 risk factors were analyzed. The meta-analysis results showed that the risk factors for SSI after lower extremity long bone fracture surgery in China included: gender (male) (OR=1.21, 95%CI: 1.00-1.46), smoking (OR=1.81, 95%CI: 1.42-2.29), diabetes mellitus (OR=2.54, 95%CI: 1.72-3.77), open fracture (OR=5.34, 95%CI: 2.73-10.45), operation time (SMD=0.85, 95%CI: 0.11-1.59), intraoperative blood loss (SMD=0.22, 95%CI: 0.07-0.37), hospital stay (SMD=1.08, 95%CI: 0.46-1.70), osteofascial compartment syndrome (OR=7.81, 95%CI: 2.94-20.74), emergency surgery (OR=2.78, 95%CI: 1.89-4.10) and high-energy injury (OR=1.63, 95%CI: 1.18-2.25). In contrast, eight factors, including age, body mass index (BMI), alcohol consumption, hypertension, preoperative time, multiple fractures, prophylactic use of antibacterial agents and postoperative drainage, showed no statistically significant association with SSI. CONCLUSIONS The occurrence of SSI after lower extremity long bone fracture surgery in China is associated with multiple risk factors. Medical staff should focus on the aforementioned major risk factors and implement targeted intervention measures to reduce the incidence rate of postoperative SSI.