Epidemiology of ankle fractures: stability and change over two decades

Ankle fractures are common lower-limb injuries with substantial effects on mobility and healthcare needs. This study characterised the demographic and morphological distribution of dislocated ankle fractures and compared the findings with a cohort treated approximately two decades earlier.

This retrospective study included 436 adults with dislocated ankle fractures treated at the Military University Hospital Prague between 2018 and 2020. Age, sex, laterality, fracture morphology, medial structure involvement, posterior malleolar and syndesmotic injuries, treatment type, and body mass index (BMI) were analysed. Aggregate results were compared with a historical cohort of 232 patients treated in 1999.

Women comprised 52.5% of the cohort. The most frequent age group was 40-49 years overall and among men, whereas women were most frequently affected at 60-69 years. The median age was 51 years and was higher in women than in men (58 vs. 44 years, p < 0.001). Right-sided fractures accounted for 53.2% of cases. Among 413 fibular fractures, 61.5% were Weber B, 20.3% Weber C, and 18.2% Weber A. Medial malleolar fractures occurred in 32.3% of evaluable patients, deltoid ligament lesions in 19.3%, posterior malleolar fractures in 34.6%, and syndesmotic injuries in 19.7%. Overall, 60.1% of patients were overweight or obese, and BMI was associated with several fracture characteristics and surgical treatment. Compared with the historical cohort, sex distribution and posterior malleolar fracture frequency were similar, whereas Weber fracture types and medial structure involvement differed significantly.

Selected characteristics, particularly sex distribution and posterior malleolar fracture frequency, were similar between the two cohorts. Differences in Weber fracture types and medial structure involvement should be interpreted in view of changes in imaging, diagnostic criteria, and cohort composition. The observed associations with BMI warrant further investigation in multicentre population-based studies using standardised assessment methods.