Cent Eur J Public Health 2026, 34(3):203-208 | DOI: 10.21101/cejph.a8913

Epidemiology of ankle fractures: stability and change over two decades

Jan Frühauf1, Václav Vaněček1, Petr Fojtík1, Michal Tuček1, Anna Horňáková2
1 Department of Orthopaedics, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
2 Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, Prague, Czech Republic

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: ankle fractures, epidemiology, Weber classification, medial structures, posterior malleolus, syndesmotic injury, body mass index

Received: January 13, 2026; Revised: July 22, 2026; Accepted: July 22, 2026; Published: September 30, 2026  Show citation

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Frühauf J, Vaněček V, Fojtík P, Tuček M, Horňáková A. Epidemiology of ankle fractures: stability and change over two decades. Cent Eur J Public Health. 2026;34(3):203-208. doi: 10.21101/cejph.a8913.
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    References

    1. Bartoníček J, Džupa V, Frič V, Pacovský V, Skála-Rosenbaum J, Svatoš F. [Epidemiology and economic implications of fractures of the proximal femur, proximal humerus, distal radius and fracture-dislocation of the ankle]. Rozhl Chir. 2008;87(4):213-9. Czech.
    2. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691-7.
    3. Somersalo A, Paloneva J, Kautiainen H, Lönnroos E, Heinänen M, Kiviranta I. Incidence of fractures requiring inpatient care. Acta Orthop. 2014;85(5):525-30.
    4. Bauer M, Jonsson K, Nilsson B. Thirty-year follow-up of ankle fractures. Acta Orthop Scand. 1985;56(2):103-6.
    5. Bengnér U, Johnell O, Redlund-Johnell I. Epidemiology of ankle fracture 1950 and 1980: increasing incidence in elderly women. Acta Orthop Scand. 1986;57(1):35-7.
    6. Daly PJ, Fitzgerald RH Jr, Melton LJ, Ilstrup DM. Epidemiology of ankle fractures in Rochester, Minnesota. Acta Orthop Scand. 1987;58(5):539-44.
    7. Elsoe R, Ostgaard SE, Larsen P. Population-based epidemiology of 9767 ankle fractures. Foot Ankle Surg. 2018;24(1):34-9.
    8. Fenelon C, Galbraith JG, Fahey T, Kearns SR. The operative treatment of ankle fractures: a 10-year retrospective study of 1529 patients. J Foot Ankle Surg. 2021;60(4):663-8.
    9. Hintermann B, Regazzoni P, Lampert C, Stutz G, Gächter A. Arthroscopic findings in acute fractures of the ankle. J Bone Joint Surg Br. 2000;82(3):345-51.
    10. 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(1):48-50.
    11. Juto H, Nilsson H, Morberg P. Epidemiology of adult ankle fractures: 1756 cases identified in Norrbotten County during 2009-2013 and classified according to AO/OTA. BMC Musculoskelet Disord. 2018;19(1):441. doi: 10.1186/s12891-018-2326-x. Go to original source...
    12. Lindsjö U. Operative treatment of ankle fractures. Acta Orthop Scand Suppl. 1981;189:1-131.
    13. Lorez LG, Hintermann B. [The relevance of ankle-fracture-associated lesions: a prospective study]. Unfallchirurg. 1999;102(12):949-54. German.
    14. Neumann AP, Rammelt S. Ankle fractures involving the posterior malleolus: patient characteristics and 7-year results in 100 cases. Arch Orthop Trauma Surg. 2022;142(8):1823-34.
    15. Rammelt S, Bartoníček J, Kroker L. Pathoanatomy of the anterolateral tibial fragment in ankle fractures. J Bone Joint Surg Am. 2022;104(4):353-63.
    16. Sakaki MH, Matsumura BA, Dotta TA, Pontin PA, Dos Santos AL, Fernandes TD. Epidemiologic study of ankle fractures in a tertiary hospital. Acta Ortop Bras. 2014;22(2):90-3.
    17. Scheer RC, Newman JM, Zhou JJ, Oomen AJ, Naziri Q, Shah NV, et al. Ankle fracture epidemiology in the United States: patient-related trends and mechanisms of injury. J Foot Ankle Surg. 2020;59(3):479-83.
    18. Thur CK, Edgren G, Jansson KÅ, Wretenberg P. Epidemiology of adult ankle fractures in Sweden between 1987 and 2004: a population-based study of 91,410 Swedish inpatients. Acta Orthop. 2012;83(3):276-81.
    19. Weber BG. [Injuries of the upper ankle joint]. Bern: Huber; 1966. German.
    20. Jehlička D, Bartoníček J, Svatoš F, Dobiáš J. [Fracture-dislocations of the ankle joint in adults. Part I: epidemiologic evaluation of patients during a 1-year period]. Acta Chir Orthop Traumatol Cech. 2002;69(4):243-7. Czech.
    21. Armstrong MEG, Cairns BJ, Banks E, Green J, Reeves GK, Beral V; Million Women Study Collaborators. Different effects of age, adiposity and physical activity on the risk of ankle, wrist and hip fractures in postmenopausal women. Bone. 2012;50(6):1394-400.
    22. Stavem K, Naumann MG, Sigurdsen U, Utvåg SE. Association of body mass index with the pattern of surgically treated ankle fractures using two different classification systems. J Foot Ankle Surg. 2017;56(2):314-8.
    23. Bartoníček J, Rammelt S, Kostlivý K, Vaněček V, Klika D, Trešl I. Anatomy and classification of the posterior tibial fragment in ankle fractures. Arch Orthop Trauma Surg. 2015;135(4):505-16.
    24. Ježek J, Skála-Rosenbaum J, Čech P, Svatoš F, Vránová J, Marvan J. [Injury of medial structures in ankle fractures: epidemiological aspects and outcomes of treatment]. Acta Chir Orthop Traumatol Cech. 2019;86(3):199-204. Czech.
    25. Marvan J, Bělehrádková H, Džupa V, Báča V, Krbec M. [Epidemiological, morphological and clinical aspects of ankle fractures]. Acta Chir Orthop Traumatol Cech. 2012;79(3):269-74. Czech.
    26. Lauge-Hansen N. Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg (1920). 1950;60(5):957-85.
    27. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma. 2018;32 Suppl 1:S1-S170.

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