Introduction: Bimodal distribution of Chinese adults reported an overall 8.7% of all femoral fractures were reported in recent years. The soft tissue dissection during surgery results in impairment in already damaged soft tissue. This impairment leads to postoperative complications. Aim: To determine the incidence and risk predictors of surgical site infections in distal femur fracture treated by open reduction and internal fixations. Methodology: We divided all recruited patients into two groups based on the occurrence of SSI. We classified patients with SSI in the case group and without SSI in the control group. Superficial SSI was defined as the infiltration on the skin or subcutaneous tissue of the operation site. The definition of the deep SSI was based on the satisfaction regarding deep fascia infection, persistent wound effusion, local abscess requiring focal debridement, and implant replacements. Wound exudates of all patients were sent for evaluation culture and sensitivity. A cohort study, This study was conducted at Peoples University of Medical __ampersandsignamp; Health Sciences Nawabshah, Pakistan from December 2019 to December 2020. Results: We observed 22 cases of SSI with a median time duration of 14 ranging from 2 to 106 days. The majority of the SSI cases were reported during hospitalization (81.2%, 18/22). Furthermore, we observed 2.4% superficial SSI and 3.6% deep SSI with an overall prevalence of 6%. The average age of patients was reported as 53.7 __ampersandsignplusmn; 17.0 years with three median ages of groups (34, 51, and 68 years respectively). Conclusion: Our results revealed a high probability of SSI in open fractures, however, the prevalence was 6%. Independent risk factors like A/G levels may play a role as defensive factors. We recommend conducting case-control trials to check the validity of our results.