Journal of Musculoskeletal Trauma

Original Articles

Risk factors for ankle fractures in older adults based on clinical components of the Fracture Risk Assessment (FRAX) tool and comorbidities in Korea: a retrospective case-control study: Myeong Jun Song, Se Woong Jang, Jun Young Lee, Seojin Park; J Musculoskelet Trauma 2025;38(4):193-202. Published online October 24, 2025; DOI: https://doi.org/10.12671/jmt.2025.00143

Abstract PDF: Background
Ankle fractures are common in older adults; however, their relationship with osteoporotic fractures remains unclear. This study aimed to evaluate potential risk factors for ankle fractures in older adults by analyzing individual clinical components of the Fracture Risk Assessment (FRAX) tool and comorbidities.
Methods
We conducted a retrospective case-control study including 84 patients aged ≥65 years with ankle fractures and 150 controls who underwent bone mineral density (BMD) testing without prior ankle fractures. The variables analyzed included age, sex, body mass index, smoking, alcohol consumption, prior fracture history, and comorbidities such as hypertension, diabetes mellitus, and dementia. BMD was measured at the spine, total hip, and femoral neck.
Results
Univariate analysis showed that alcohol consumption, diabetes mellitus, and total hip T-score categories were significantly associated with ankle fractures. In binary logistic regression, alcohol consumption remained significantly associated with lower ankle fracture risk (odds ratio [OR], 0.196; 95% confidence interval [CI], 0.066–0.589; P=0.004), and osteoporosis at the total hip was associated with decreased risk (OR, 0.253; 95% CI, 0.069–0.934; P=0.039), whereas osteopenia was not (OR, 1.258; 95% CI, 0.700–2.263; P=0.443). Diabetes mellitus was marginally significant in the adjusted model (OR, 1.838; 95% CI, 0.973–3.472; P=0.061). The Hosmer-Lemeshow test showed no evidence of poor fit (P=0.214).
Conclusions
These findings suggest that alcohol consumption and total hip osteoporosis were inversely associated with ankle fractures in older adults; however, these associations should be interpreted with caution given the hospital-based selection of controls and the small number of exposed cases, and further studies are needed to clarify them. The FRAX score itself was not calculated; instead, this study focused on analyzing selected clinical components. Limitations include the retrospective design, lack of fall and medication data, and cross-sectional BMD assessment. Level of evidence: III.

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Results of Intramedullary Nailing for Distal Metaphyseal Intra-Articular Fractures of Tibia: Jun Young Lee, Yongjin Cho, Hyung Seok Park, Se Woong Jang; J Korean Fract Soc 2020;33(4):196-203. Published online October 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.4.196

Abstract PDF: Purpose
This study examined the results of internal fixation using an intramedullary nail in the treatment of distal metaphyseal fractures involving the articular surface.
Materials and Methods
From November 2009 to November 2018, distal tibia fractures involving the articular surface were treated with intramedullary nailing only for fractures corresponding to AO type 43 B and 43 C1, twenty-four cases were studied retrospectively. The tibial alignment was measured preoperatively and postoperatively, and the bone union time and nonunion were assessed. In addition, the clinical evaluation of ankle joint function was assessed using the Olerud and Molander ankle score (OMAS).
Results
Complete bone union was obtained in all cases, and the mean union time was 17.7±1.87 weeks (range, 15-20 weeks). The average preoperative coronal alignment was 6.4°±1.0° (range, 5.2°-8.4°), and sagittal alignment was 2.7°±0.6° (range, 1.9°-3.8°). The average postoperative coronal alignment was 2.5°±0.13° (range, 2.2°-2.6°) and sagittal alignment was 0.4°±0.25° (range, 0.09°-0.95°). There was no nonunion. The OMAS had an average of 85±7.9 points (range, 70-95 points).
Conclusion
In the treatment of distal metaphyseal fractures involving the articular surface, internal fixation using an intramedullary nail reduces complications and achieves satisfactory reduction and union. This method is considered an excellent treatment to obtain good clinical results.

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