Sex-based differences in pediatric lateral ankle avulsion fractures: males are more likely to sustain avulsion fractures

Objective To assess sex-based differences in the frequency and characteristics of pediatric lateral ankle avulsion fractures.Methods This prospective observational cohort study (Level II) was conducted at a tertiary sports medicine clinic between July 2022 and March 2025. This study included a total of 132 patients with 133 injuries aged 5 to 12 years presenting within 30 days of a first-time lateral ankle injury (67.4% female and 32.6% male). Injuries were categorized as avulsion or non-avulsion using ultrasound as the reference standard. Demographics, injury type and mechanism, sport type, and validated patient-reported measures were analyzed by sex using chi-squared and Mann-Whitney U tests.Results Males were found to be significantly more likely to sustain lateral ankle avulsion fractures than their female counterparts (50.0% vs 24.1%, p < 0.01). There were no statistically significant differences between the avulsion and non-avulsion group for age, race, ethnicity, BMI, or days to presentation. Sport during injury did vary by sex (p = 0.02), but the cause of injury did not. Pain, mobility, anxiety, and Pedi-FABS scores did not vary between sexes at presentation, regardless of their avulsion status.Conclusions Our study demonstrated that males with lateral ankle injuries were more likely to sustain avulsion fractures than females in this pediatric population. Despite these differences in injury type, both sexes reported similar levels of function, anxiety, pain, and activity at initial presentation. Understanding early sex-based differences in lateral ankle fracture patterns may inform diagnostic evaluation and management in pediatric patients.