Population-based epidemiology of 9767 ankle fractures☆
Introduction
Fractures of the ankle are common injuries reported as 10.2% of all bone injuries [1]. The incidence is reported in a number of studies including both selected and non-selected patient groups [1], [2], [3], [4], [5], [6], [7], [8]. Court-Brown [1] reported an overall incidence of 137.7/100,000/year in Edinburgh including all patients above 15 years in 2010–2011.
The mean age of patients with ankle fractures is reported as 49 years with a bimodal distribution with peaks in younger males and older females, but with an overall even gender distribution (male 46%/female 54%) [1], [3].
The fracture distribution according to the OTA classification [9] is reported as 24.1% of Type A, 65.8% of Type B and 10.1% of Type C [1]. Unimalleolar fractures represent 70% of all fractures, bimalleolar fractures 20% and trimalleolar fractures about 10% [1], [3], [6].
The most common mechanism of injury is reported as a fall from standing height representing about 80% of all fractures [1], [3]. Court-Brown [1] reported that 20.8% of all Type C fractures were caused by sports injuries, with an average age of 32.5 years in patients and that all were males.
A number of studies in the past decades have reported an increasing incidence of ankle fractures. This is primarily thought to be caused by the growth in the number of people participating in sports and a shift in demographics towards an elderly population [1], [2], [3]. Change in incidence, fracture pattern and demographics with time are commonly reported for many different fracture types [1], [10], [11], [12].
Despite fractures of the ankle being very common, recent literature concerning the epidemiology of ankle fractures is scarce. The incidence and epidemiology of ankle fractures are inconstant [3], and the literature lacks large-scale and recent population-based epidemiological studies of ankle fractures including all age groups, all fractures and studies based on accurate population sizes.
The purpose of this study was to provide up-to-date information concerning the incidence of ankle fractures in a large and complete population including all age groups spanning a decade. Furthermore, the purpose was to report the distribution of fractures, trauma mechanism and patient baseline demographics.
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Materials and methods
At Aalborg University Hospital, Denmark, a population-based epidemiological study of all patients treated for an ankle fracture was carried out over a 10-year period from 2005 to 2014.
The study was conducted in the North Denmark Region, and was based on an average population of 579,119 citizens (Fig. 1). The region is served by Aalborg University Hospital (Level 1 Trauma Centre) and six minor hospitals. All patients in the Region treated for an ankle fracture from 2005 to 2014 were included.
Results
A total of 9767 patients with ankle fractures were treated between 2005 and 2014. The mean age at time of fracture was 41.4 (24.3 SD) years. The mean age for males was 35.5 (21.9 SD) years, and females 46.4 (25.1 SD) years. The gender distribution was 5178 (53.0%) females and 4586 (47.0%) males.
The mean incidence of ankle fractures between 2005 and 2014 was 168.7/100,000/year. For males, the incidence was 157.1/100,000/year, and for females, 179.5/100,000/year. The incidence shows a peak in
Discussion
Despite ankle fractures being common, little has been written regarding epidemiology in recent years. The present study shows an incidence of 168.7/100,000/year from a non-selected patient group with ankle fractures. This is considerably higher than Court-Brown [1], reporting an overall incidence of 100.8/100,000/year in 2000 and 137.7/100,000/year in 2014 in a patient group from Edinburgh including all patients above 15 years. Moreover, Thur et al. [18] reported a considerable lower incidence
Conclusions
This study shows an incidence of 168.7/100,000/year spanning a decade. The incidence shows a peak incidence among adolescents in both genders with a male predominance. After the age of 19 the male incidence declines with age, which is in contrast to women, who experience an increasing incidence. The most common fracture type in all age groups was a fracture of the lateral malleolus representing 55% of all fractures. The mode of injury was predominantly falls (61%) followed by sports (22%).
Conflict of interest
The authors wish to certify that no actual or potential conflict of interest or financial conflicts exist in relation to this manuscript article.
Funding
The authors did not receive benefits or grants in any form from a commercial party related directly or indirectly to the subject of this article.
Acknowledgements
The Department of Orthopaedic Surgery and the Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Denmark are acknowledged for providing unrestricted grants.
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Original paper for Foot & Ankle Surgery: http://www.footanklesurgery-journal.com/content/aims.