Epidemiological Trends and Thromboembolic Risks in Bimalleolar and Trimalleolar Ankle Fractures: A Retrospective Analysis of Increasing Incidence in an Aging Population
Kerollos Ibrahim, Neha Jayarajan, Apurvakumar Patel, Ashkan SedighObjective
The incidence of bimalleolar (BMF) and trimalleolar fractures (TMF) is increasing. This study assesses the epidemiological trends of bimalleolar (BMF) and trimalleolar fractures (TMF) and subsequent complications, including venous thromboembolism events (VTE).
Methods
We conducted a retrospective analysis using the TriNetX Network, which provided data from electronic medical records of 97 healthcare organizations. Patients diagnosed with BMF from 2017 to 2023 were identified using international classification of deseases 10th edition (ICD-10) codes, including S82.841A, S82.842A, and S82.843A for displaced fractures, and S82.844A, S82.845A, and S82.846A for nondisplaced fractures. For trimalleolar fractures, the codes used were S82.851A, S82.852A, and S82.853A for displaced fractures, and S82.854A, S82.855A, and S82.856A for nondisplaced fractures. Demographic data were analyzed alongside fracture displacement and VTE complications.
Results
The study analyzed 59,315 patients with bimalleolar fractures and 45,335 with trimalleolar fractures, showing that a majority of patients were older women. Displaced fractures predominated, with 89% (52,730 cases) for BMF and 90% (40,802 cases) for TMF. The incidence of thromboembolic complications was notably high, particularly in the immediate post-fracture period. VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE), was recorded in 1,218 patients (1.1% of fractures), where 42% occurred between ages 40-64 within the first week.
Conclusion
The predominance of displaced fractures and the acute onset of VTE post-fracture underscore the need for a nuanced approach to fracture management, early rehabilitation, supervised weight bearing, partial weight-bearing monitoring and programming, and early DVT prediction, particularly in older adults. Further studies should be performed to further understand and refine current guidelines and address healthcare disparities.