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. 2021 Oct 1;16(5):1313-1322.
doi: 10.26603/001c.27912. eCollection 2021.

Fractures and Chronic Recurrence are Commonly Associated with Ankle Sprains: a 5-year Population-level Cohort of Patients Seen in the U.S. Military Health System

Daniel I Rhon  1 , Tina A Greenlee  2 , Chad E Cook  3 , Richard B Westrick  4 , Jon A Umlauf  3 , John J Fraser  5
Affiliations

Fractures and Chronic Recurrence are Commonly Associated with Ankle Sprains: a 5-year Population-level Cohort of Patients Seen in the U.S. Military Health System

Daniel I Rhon et al. Int J Sports Phys Ther. .

Abstract

Background: Whereas ankle-foot injuries are ubiquitous and affect ~16% of military service-members, granularity of information pertaining to ankle sprain subgroups and associated variables is lacking. The purpose of this study was to characterize and contextualize the burden of ankle sprain injuries in the U.S. Military Health System.

Methods: This was a retrospective cohort study of beneficiaries seeking care for ankle sprains, utilizing data from the Military Health System Data Repository from 2009 to 2013. Diagnosis and procedural codes were used to identify and categorize ankle sprains as isolated lateral, isolated medial, concomitant medial/lateral, unspecified, or concomitant ankle sprain with a malleolar or fibular fracture. Patient characteristics, frequency of recurrence, operative cases, and injury-related healthcare costs were analyzed.

Results: Of 30,910 patients included, 68.4% were diagnosed with unspecified ankle sprains, 22.8% with concomitant fractures, (6.9%) with isolated lateral sprains, (1.7%) with isolated medial sprains and 0.3% with combined medial/lateral sprains. Pertaining to recurrence, 44.2% had at least one recurrence. Sprains with fractures were ~2-4 times more likely to have surgery within one year following injury (36.2% with fractures; 9.7% with unspecified sprains) and had the highest ankle-related downstream costs.

Conclusion: Fractures were a common comorbidity of ankle sprain (one in five injuries), and operative care occurred in 16.4% of cases. Recurrence in this cohort approximates the 40% previously reported in individuals with first-time ankle sprain who progress to chronic ankle instability. Future epidemiological studies should consider reporting on subcategories of ankle sprain injuries to provide a more granular assessment of the distribution of severity.

Level of evidence: 3b.

Keywords: ankle fracture; ankle sprain; epidemiology; injury severity; military medicine; tactical athlete.

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Conflict of interest statement

No authors have any competing or conflicts of interest to declare

Figures

Figure 1.
Figure 1.. Flow of Cohort Selection
Figure 2.
Figure 2.. Proportion within ankle injury subgroups
See this image and copyright information in PMC

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References

    1. Epidemiology of collegiate injuries for 15 sports: Summary and recommendations for injury prevention initiatives. Hootman J.M., Dick R., Agel J. 2007J Athl Train. 42(2):311–319. - PMC - PubMed
    1. Comparing the population health impacts of medical conditions using routinely collected health care utilization data: Nature and sources of variability. Brundage John F., Johnson Karen E., Lange Jeffrey L., Rubertone Mark V. Oct;2006 Military Medicine. 171(10):937–942. doi: 10.7205/milmed.171.10.937. doi: 10.7205/milmed.171.10.937. - DOI - DOI - PubMed
    1. Characterization of limited duty neuromusculoskeletal injuries and return to duty times in the U.S. Army during 2017-2018. Roy T.C., Faller T.N., Richardson M.D.., et al. Jan;2021 Mil Med. doi: 10.1093/milmed/usaa392. doi: 10.1093/milmed/usaa392.. - DOI - DOI - PubMed
    1. Incidence of ankle sprains among active-duty members of the United States armed services from 1998 through 2006. Cameron Kenneth L., Owens Brett D., DeBerardino Thomas M. Jan 1;2010 Journal of Athletic Training. 45(1):29–38. doi: 10.4085/1062-6050-45.1.29. doi: 10.4085/1062-6050-45.1.29. - DOI - DOI - PMC - PubMed
    1. Sex and occupation are salient factors associated with lateral ankle sprain risk in military tactical athletes. Fraser John J., MacGregor Andrew J., Ryans Camille P., Dreyer Mark A., Gibboney Michael D., Rhon Daniel I. Jul;2021 Journal of Science and Medicine in Sport. 24(7):677–682. doi: 10.1016/j.jsams.2021.02.016. doi: 10.1016/j.jsams.2021.02.016. - DOI - DOI - PubMed