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Incidence of Patients with Lower Extremity Injuries Presenting to US Emergency Departments by Anatomic Region, Disease Category, and Age

  • Clinical Research
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Clinical Orthopaedics and Related Research®



The incidence of patients with lower extremity injuries presenting to emergency departments in the United States with respect to specific anatomic regions and disease categories is unknown. Such information might be used for injury prevention, resource allocation, and training priorities.


We determined the anatomic regions, disease categories, and circumstances that account for the highest incidence of leg problems among patients presenting to emergency departments in the United States.


We used the National Electronic Injury Surveillance System (NEISS) to obtain a probability sample of all lower extremity injuries treated at emergency departments during 2009. A total of 119,815 patients who presented to emergency departments with lower extremity injuries in 2009 were entered in the NEISS database. Patient and injury characteristics were analyzed. Incidence rates for various regions, disease categories, injuries, and age groups were calculated using US census data.


We identified 112 unique combinations of disease categories and anatomic regions. Strains and sprains accounted for 36% of all lower extremity injuries. The injury with the greatest incidence was an ankle sprain (206 per 100,000; 95% confidence interval, 181–230). Younger patients were more likely to have ankle sprains, foot contusions/abrasions, and foot strains/sprains. Older patients were more likely to have lower trunk fractures and lower trunk contusions/abrasions. The most common incidence for injury was at home (45%).


Given relatively low-acuity leg problems such as strains and sprains account for a substantial number of emergency department visits pertaining to leg problems, use of telephone triage, scheduled same or next-day urgent care appointments, and other alternatives to the traditional emergency room might result in better use of emergency healthcare resources.

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  1. Alexander K, Eager D, Scarrott C, Sushinsky G. Effectiveness of pads and enclosures as safety interventions on consumer trampolines. Inj Prev. 2010;16:185–189.

    Article  PubMed  Google Scholar 

  2. Bridgman SA, Clement D, Downing A, Walley G, Phair I, Maffulli N. Population based epidemiology of ankle sprains attending accident and emergency units in the West Midlands of England, and a survey of UK practice for severe ankle sprains. Emerg Med J. 2003;20:508–510.

    Article  PubMed  CAS  Google Scholar 

  3. Deits J, Yard EE, Collins CL, Fields SK, Comstock RD. Patients with ice hockey injuries presenting to US emergency departments, 1990–2006. J Athl Train. 2010;45:467–474.

    Article  PubMed  Google Scholar 

  4. Fernandez WG, Yard EE, Comstock RD. Epidemiology of lower extremity injuries among U.S. high school athletes. Acad Emerg Med. 2007;14:641–645.

    PubMed  Google Scholar 

  5. Fong DT, Man CY, Yung PS, Cheung SY, Chan KM. Sport-related ankle injuries attending an accident and emergency department. Injury. 2008;39:1222–1227.

    Article  PubMed  Google Scholar 

  6. Holmer P, Sondergaard L, Konradsen L, Nielsen PT, Jorgensen LN. Epidemiology of sprains in the lateral ankle and foot. Foot Ankle Int. 1994;15:72–74.

    PubMed  CAS  Google Scholar 

  7. Kannus P, Parkkari J, Sievanen H, Heinonen A, Vuori I, Jarvinen M. Epidemiology of hip fractures. Bone. 1996;18(1 suppl):57S–63S.

    Article  PubMed  CAS  Google Scholar 

  8. Koval KJ, Skovron ML, Aharonoff GB, Zuckerman JD. Predictors of functional recovery after hip fracture in the elderly. Clin Orthop Relat Res. 1998;348:22–28.

    PubMed  Google Scholar 

  9. Miyamoto RG, Kaplan KM, Levine BR, Egol KA, Zuckerman JD. Surgical management of hip fractures: an evidence-based review of the literature. I: femoral neck fractures. J Am Acad Orthop Surg. 2008;16:596–607.

    PubMed  Google Scholar 

  10. Niska R, Bhuiya F, Xu J. National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Natl Health Stat Report. 2010;26:1–31.

    PubMed  Google Scholar 

  11. Owens PL, Barrett ML, Gibson TB, Andrews RM, Weinick RM, Mutter RL. Emergency department care in the United States: a profile of national data sources. Ann Emerg Med. 2010;56:150–165.

    Article  PubMed  Google Scholar 

  12. Pillai A, Eranki V, Shenoy R, Hadidi M. Age related incidence and early outcomes of hip fractures: a prospective cohort study of 1177 patients. J Orthop Surg Res. 2011;6:5.

    Article  PubMed  Google Scholar 

  13. Schroeder T, Ault K. The NEISS sample (design and implementation) 1997 to present. U.S. Consumer product safety Commission Division of Hazard and Injury Data Systems. 2001. Available at: Accessed September 1, 2010.

  14. Smith W, Williams A, Agudelo J, Shannon M, Morgan S, Stahel P, Moore E. Early predictors of mortality in hemodynamically unstable pelvis fractures. J Orthop Trauma. 2007;21:31–37.

    Article  PubMed  Google Scholar 

  15. Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med. 1992;21:384–390.

    Article  PubMed  CAS  Google Scholar 

  16. Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA, Johns C, Worthington JR. Implementation of the Ottawa ankle rules. JAMA. 1994;271:827–832.

    Article  PubMed  CAS  Google Scholar 

  17. The National Electronic Injury Surveillance System. A Tool for Researchers. U.S. Consumer Product Safety Commission Division of Hazard and Injury Data Systems. 2000. Available at: Accessed September 1, 2010.

  18. The National Electronic Injury Surveillance System. Coding Manual. 2010. Available at: Accessed September 1, 2010.

  19. United States Census. Annual Population Estimates 2000 to 2009. Available at: Accessed September 1, 2010.

  20. United States Census. Monthly Postcensal Resident Population, by single year of age, sex, race, and Hispanic origin, 1/1/2009 to 6/1/2009. Available at: Accessed September 1, 2010.

  21. Van Tassel DC, Owens BD, Wolf JM. Incidence estimates and demographics of scaphoid fracture in the U.S. population. J Hand Surg Am. 2010;35:1242–1245.

    Article  PubMed  Google Scholar 

  22. Waterman BR, Belmont PJ Jr, Cameron KL, Deberardino TM, Owens BD. Epidemiology of ankle sprain at the United States Military Academy. Am J Sports Med.38:797–803.

  23. Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont PJ Jr. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010;92:2279–2284.

    Article  PubMed  Google Scholar 

  24. Zacchilli MA, Owens BD. Epidemiology of shoulder dislocations presenting to emergency departments in the United States. J Bone Joint Surg Am. 2010;92:542–549.

    Article  PubMed  Google Scholar 

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Correspondence to David Ring MD, PhD.

Additional information

One of the authors (KL) has received funding for his research fellowship from the Marti-Keuning Eckhardt Foundation, the Netherlands and the Anna Foundation, the Netherlands.

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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Lambers, K., Ootes, D. & Ring, D. Incidence of Patients with Lower Extremity Injuries Presenting to US Emergency Departments by Anatomic Region, Disease Category, and Age. Clin Orthop Relat Res 470, 284–290 (2012).

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