Research Article| Volume 59, ISSUE 3, P479-483, May 2020

Ankle Fracture Epidemiology in the United States: Patient-Related Trends and Mechanisms of Injury


      Current nationwide epidemiological data regarding ankle fractures are scarce. Such information is important towards better quantifying the mortality associated with such injuries, financial impact, as well as the implementation of preventative measures. This study evaluated the epidemiology of ankle fractures that occurred during a 5-year period. Specifically, we evaluated demographics, mechanism of injury, and disposition. The National Electronic Injury Surveillance System was queried to identify all patients with ankle fractures that presented to US hospital emergency departments between 2012 and 2016. Census data were used to determine the incidence rates of ankle fractures in terms of age, sex, and race. There was an estimated total of 673,214 ankle fractures that occurred during this period, with an incidence rate of 4.22/10,000 person-years. The mean age of patients with an ankle fracture was 37 ± 22.86 (SD) years; 23.5% of ankle fractures occurred in patients aged 10 to 19 years (7.56/10,000 person-years). In addition, 44% of ankle fractures occurred in men (3.81/10,000 person-years), whereas 56% occurred in women (4.63/10,000 person-years). Data on race/ethnicity were available for 71% of the subjects, with incidence rates of 2.85/10,000 person-years for whites, 3.01/10,000 person-years for blacks, and 4.08/10,000 person-years for others. The most common mechanism of injury was falls (54.83%), followed by sports (20.76%), exercise (16.84%), jumping (4.42%), trauma (2.84%), and other (0.30%). For disposition, 81.84% of patients were treated and released, 1.43% were transferred, 16.01% were admitted, 0.59% were held for observation, and 0.13% left against medical advice. The highest incidence of ankle fractures in men occurred in the 10-to-19-years age group, but women were more commonly affected in all other age groups.

      Level of Clinical Evidence


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jensen SL
        • Andresen BK
        • Mencke S
        • Nielsen PT
        Epidemiology of ankle fractures: a prospective population-based study of 212 cases in Aalborg, Denmark.
        Acta Orthop Scand. 1998; 69: 48-50
        • Mandi DM
        • Nickles WA
        • Mandracchia VJ
        • Halligan JB
        • Toney PA
        Ankle fractures.
        Clin Podiatr Med Surg. 2006; 23: 375-422
        • Mehta SS
        • Rees K
        • Cutler L
        • Mangwani J
        Understanding risks and complications in the management of ankle fractures.
        Indian J Orthop. 2014; 48: 445-452
      1. Hsu RY, Lee Y, Hayda R, Digiovanni CW, Mor V, Bariteau JT. Morbidity and mortality associated with geriatric ankle fractures: a Medicare Part A claims database analysis. J Bone Joint Surg Am2015;97:1748–1755.

        • Seewoonarain S
        • Prempeh M
        • Shakokani M
        • Magan A
        Ankle fractures: review article.
        J Arthritis. 2015; 5: 1-4
        • Ovaska M.
        Complications in ankle fracture surgery.
        Acta Orthop. 2015; 86: 1-35
        • Belmont PJ
        • Davey S
        • Rensing N
        • Bader JO
        • Waterman BR
        • Orr JD
        Patient-based and surgical risk factors for 30-day postoperative complications and mortality after ankle fracture fixation.
        J Orthop Trauma. 2015; 29: e476-e482
        • Avilucea FR
        • Greenberg SE
        • Grantham WJ
        • Sathiyakumar V
        • Thakore R V
        • Nwosu SK
        • Archer KR
        • Obremskey WT
        • Mir HR
        • Sethi MK
        The costs of operative complications for ankle fractures: a case control study.
        Adv Orthop. 2014; 2014709241
        • Sanders R
        • Pappas J
        • Mast J
        • Helfet D
        The salvage of open grade IIIB ankle and talus fractures.
        J Orthop Trauma. 1992; 6: 201-208
        • Centers for Medicare & Medicaid Services
        National Health Expenditure Projections 2016-2025.
        (Available from:)
        • Belatti DA
        • Phisitkul P.
        Economic burden of foot and ankle surgery in the US Medicare population.
        Foot Ankle Int. 2014; 35: 334-340
        • Murray AM
        • McDonald SE
        • Archbold P
        • Crealey GE
        Cost description of inpatient treatment for ankle fracture.
        Injury. 2011; 42: 1226-1229
        • Manoukian D
        • Leivadiotou D
        • Williams W
        Is early operative fixation of unstable ankle fractures cost effective? Comparison of the cost of early versus late surgery.
        Eur J Orthop Surg Traumatol. 2013; 23: 835-837
        • Daly PJ
        • Fitzgerald RH
        • Melton LJ
        • Llstrup DM
        Epidemiology of ankle fractures in Rochester, Minnesota.
        Acta Orthop. 1987; 58: 539-544
        • Somersalo A
        • Paloneva J
        • Kautiainen H
        • LÖNnroos E
        • HEinÄNen M
        • Kiviranta I
        Increased mortality after lower extremity fractures in patients <65 years of age.
        Acta Orthop. 2016; 87
        • Schwartz O
        • Malka I
        • Olsen CH
        • Dudkiewicz I
        • Bader T
        Overuse injuries in the IDF's combat training units: rates, types, and mechanisms of injury.
        Mil Med. 2018; 183: e196-e200
        • Khan M
        • Madden K
        • Burrus MT
        • Rogowski JP
        • Stotts J
        • Samani MJ
        • et al.
        Epidemiology and impact on performance of lower extremity stress injuries in professional basketball players.
        Sports Health. 2018; 10: 169-174
        • The National Electronic Injury Surveillance System (NEISS)
        US Consumer Product Safety Commission.
        2000 (Accessed July 10, 2017. n.d)
      2. NEISS - The National Electronic Injury Surveillance System A Tool for Researchers. Div Hazard Inj Data Syst US Consum Prod Saf Comm 2000:1–38.

        • Schroeder T
        • Ault K.
        The NEISS sample (design and implementation) 1997 to Present.
        Washington, DC, US Consumer Product Safety Commission2001 (n.d)
        • Shibuya N
        • Davis ML
        • Jupiter DC
        Epidemiology of foot and ankle fractures in the United States: an analysis of the National Trauma Data Bank (2007 to 2011).
        J Foot Ankle Surg. 2014; 53: 606-608
        • Ross JS
        • Normand SLT
        • Wang Y
        • Nallamothu BK
        • Lichtman JH
        • Krumholz HM
        Hospital remoteness and thirty-day mortality from three serious conditions.
        Health Aff. 2008; 27: 1707-1717
        • Miller MK
        • Farmer FL CL
        Rural populations and their health.
        Rural Heal. Serv. A Manag. Perspect. 1994; : 3-26
        • Kim SH
        • Szabo RM
        • Marder RA
        Epidemiology of humerus fractures in the United States: nationwide emergency department sample, 2008.
        Arthritis Care Res. 2012; 64: 407-414
        • Larsen P
        • Court-Brown CM
        • Vedel JO
        • Vistrup S
        • Elsoe R
        Incidence and epidemiology of patellar fractures.
        Orthopedics. 2016; 39: e1154-e1158
        • Phillips WA
        • Al Fto E
        A prospective, randomized study of the management of severe ankle fractures.
        J Bone Joint Surg Am. 1985; 67: 12
        • Court-Brown CM
        • Caesar B.
        Epidemiology of adult fractures: A review.
        Injury. 2006; 37: 691-697
        • Elsoe R
        • Ostgaard SE
        • Larsen P
        Population-based epidemiology of 9767 ankle fractures.
        Foot Ankle Surg. 2016;
        • Pisani P
        • Renna MD
        • Conversano F
        • Casciaro E
        • Di Paola M
        • Quarta E
        • et al.
        Major osteoporotic fragility fractures: risk factor updates and societal impact.
        World J Orthop. 2016; 7: 171
        • Ensrud KE.
        Epidemiology of fracture risk with advancing age.
        J Gerontol Ser A Biol Sci Med Sci. 2013; 68: 1236-1242
        • Liang W
        • Chikritzhs T.
        The effect of age on fracture risk: a population-based cohort study.
        J Aging Res. 2016; (2016)
        • Unnanuntana A.
        The assessment of fracture risk.
        J Bone Joint Surg Am. 2010; 92: 743
        • Kanis J a
        • Borgstrom F
        • De Laet C
        • Johansson H
        • Johnell O
        • Jonsson B
        • et al.
        Assessment of fracture risk.
        Osteoporos Int. 2005; 16: 581-589