Trends in geriatric ankle fractures in the United States: An 8-year analysis

Ankle fractures are among the most common fractures in older adults, associated with substantial morbidity and healthcare burden. This study aimed to evaluate recent trends in incidence and injury characteristics of ankle fractures among adults aged ≥65 years presenting to United States emergency departments.

The National Electronic Injury Surveillance System (NEISS) database was queried for ankle fractures in adults aged ≥65 years from 2016 to 2023. Demographics, injury mechanisms, fracture types, and hospitalization rates were analyzed. Annual incidence rates per 100,000 persons were calculated. Trends over time, as well as age- and sex-specific differences, were analyzed.

An estimated 241,449 ankle fractures occurred among adults aged ≥65 years between 2016 and 2023, with an overall incidence rate of 55.8 per 100,000 person-years. The incidence increased from 49.1 to 63.0 per 100,000 persons during the study period (P < 0.0001). Incidence rates increased significantly in both males (from 25.7 to 34.7 per 100,000 persons; P < 0.0001) and females (from 67.7 to 86.4 per 100,000 persons; P < 0.0001). Most fractures occurred in women (76.2 %), resulted from low-energy trauma (92.8 %), and were closed fractures (96.9 %). Open fracture incidence rose from 0.64 to 2.40 per 100,000 persons, representing a 275 % increase (P < 0.0001). Hospitalization rates increased from 20.3 to 29.7 per 100,000 persons (P < 0.0001). Women aged ≥80 years accounted for the highest fracture burden. Women were more likely to sustain low-energy injuries (P < 0.0001), while men had a higher proportion of open fractures (P = 0.011). Hospitalization rates increased with age, reaching 56.6 % among patients aged ≥80 years (P < 0.0001).

Ankle fracture incidence among older adults in the U.S. increased significantly from 2016 to 2023, with rising rates in both males and females. Low-energy mechanisms remain the predominant cause in this population. Further studies are needed to identify optimal surgical treatments and rehabilitation strategies. Improving bone health and reducing morbidity and mortality remain key priorities in managing geriatric ankle fractures.