Epidemiology of Adult Ankle Fractures: 1756 cases identified in Norrbotten County during 2009-2013 and classified according to AO/OTA

Hans Juto, Helena Nilsson, Per Morberg, Hans Juto, Helena Nilsson, Per Morberg

Abstract

Background: The ankle fracture is one of the most common fractures, increasing in an ageing population, but not generally seen as an osteoporotic fracture. The aim of this study was to examine the relationship between different AO/OTA classes of ankle fractures, age, sex and type of trauma.

Methods: Ankle fractures, treated at any of the hospitals in Norrbotten County in Sweden between 2009 and 2013, were retrospectively identified and classified according to the AO/OTA-classification system. Information about the trauma mechanism was also obtained.

Results: In Norrbotten County, 1756 ankle fractures in 1735 patients aged 20 years or older were identified. This gave an incidence in the county of 179 per 100,000 person-years. Of these patients, 34.6% were 65 years or older, 58.4% were women and 68.2% of the trauma leading to a fracture was defined as low-energy. In 1.5% of the cases the fractures were open. Incidences of type B fractures increased substantially with age, from 62 (95% CI 50-77) at 30-39 years of age to 158 (95% CI 131-190) in patients older than 80 years of age per 100,000 person-years. Type B fractures showed a slightly higher proportion of low-energy trauma while type C showed a lower mean age and proportion of women.

Conclusions: This study shows an incidence of 179 adult ankle fractures annually per 100,000 persons. More than two thirds of the fractures were caused by a low-energy trauma and ankle fractures are more frequent among females. Females generally have an increased incidence during their life, mainly between the ages of 30 and 60. This is in contrast to men who have more of an even distribution throughout their life. Classification according to AO/OTA reveals some heterogeneity among the classes of ankle fractures in age and gender as well as the energy involved in the trauma.

Keywords: AO/OTA-classification; Ankle fracture; Epidemiology; Incidence; Osteoporosis.

Conflict of interest statement

Ethics approval and consent to participate

Ethical approval for the study was obtained from the regional ethic committee at Umeå University (D-nr 2014/143–31). Consent to participate for the included patients in the study was not required in the ethical approval.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow-chart identification of ankle fracture in computerized medical documentation system
Fig. 2
Fig. 2
Incidence per 100,000 person and year according to AO/OTA type and age. Ninety five percent CI was calculated using Mid-P exact test
Fig. 3
Fig. 3
Incidence per 100,000 persons and year according to gender and age. Ninety five percent CI was calculated using Mid-P exact test
Fig. 4
Fig. 4
Distribution of fractures throughout the year. Ninety five percent CI was calculated using Wilson method
Fig. 5
Fig. 5
Distribution of fractures throughout the week. Ninety five percent CI was calculated using Wilson method

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