Ankle fractures rank as the third most common fracture of the appendicular skeleton among the elderly, surpassed only by hip, wrist fractures [1]. Though often considered to be less impactful than other geriatric fractures, these injuries impose a substantial healthcare burden, with over 2 million cases documented annually in the United States (U.S.) and related costs exceeding $17 billion [[2], [3], [4], [5]]. Moreover, ankle fractures are significant indicators of morbidity, with one-year mortality rates as high as 12 % [6]. While global trends underscore an increase in ankle fractures due to aging populations [[5], [6], [7], [8], [9], [10]], the incidence rate among individuals aged 60 and older in the U.S. from 2012 to 2016 has remained relatively stable, ranging from 4 to 6 per 10,000 person-years. However, among the super elderly (≥80 years), particularly females, the incidence of ankle fractures increased over this time period [11].

Existing literature in the U.S. provides valuable insights into the management and outcomes of ankle fractures [11,12]. Managing ankle fractures in older adults presents significant challenges due to the prevalence of comorbidities such as metabolic disorders, cardiovascular disease, osteoporosis and impaired circulation [13,14]. Additionally, mobility limitations and various social factors can prolong recovery and increase the risk of complications [15]. However, a need remains for a more focused and contemporary analysis of their epidemiology within the elderly population.

Given the clinical and economic implications of ankle fractures in the elderly, understanding current trends and epidemiology is crucial. This study aims to analyze the trends, incidence and characteristics of ankle fractures among adults over 65 years old presenting to U.S. emergency departments (ED) over an eight-year period. Additionally, sex- and age-based analyses will be conducted to examine variations in injury patterns and patient management. We hypothesize that the incidence of ankle fractures has increased over time and that significant differences exist in fracture patterns and management based on sex and age.