ArticleBMC musculoskeletal disorders2026
Epidemiology of non-unions following foot and ankle fractures: a nationwide analysis from 2014 to 2023.
Article in BMC musculoskeletal disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNon-unions are a common complication following fractures. Although fractures of the foot and ankle are frequent, reliable data on the incidence and epidemiology of non-unions in these regions are lacking.
methodsA nationwide retrospective analysis was conducted using inpatient data from the German Federal Statistical Office between 2014 and 2023. Fractures and non-unions of the foot and ankle were identified via ICD-10 coding, with two cohorts defined: fracture cases and non-union cases. Data were stratified by age and sex, and all co-coded secondary diagnoses were extracted and aggregated to identify the most frequent comorbidities. Temporal trends were assessed using linear regression, while age distributions were modelled with two-component Gaussian mixture models to capture distinct etiological subpopulations. Data processing, statistical analyses, and visualization were performed in R (Version 4.3) using Tidyverse packages.
resultsBetween 2014 and 2023, 992,360 foot and ankle fractures and 20,268 non-unions of the foot and ankle were treated in hospitalized patients in German hospitals. Women were more frequently affected by both fractures and non-unions than men. The age distribution was bimodal, with peaks at 18–29 and 50–59 years in men, and at 50–79 years in women. The overall non-union rate was 2.0% and showed a declining trend over time. Age- and sex-specific differences were observed, with the highest non-union rate in women aged 40–49 years (3.2%). Comorbidities including obesity, allergies, depressive episodes, asthma, and sleep disorders were more prevalent in patients with non-unions compared to those with fractures.
conclusionsNon-unions following fractures of the foot and ankle remain rare and have declined steadily over the past decade. Age- and sex-specific differences underscore the need for targeted prevention strategies.
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