BACKGROUND: Ankle fractures are the third most common fractures, often requiring surgical intervention to restore function and mobility. Understanding trends in ankle fracture surgeries is essential for optimizing treatment strategies and improving patient outcomes. The aim of this study is to provide a comprehensive analysis of ankle fracture surgeries in Sweden in order to highlight changes in demography and trends in surgical procedures. METHODS: Utilizing data from the National Patient Register, we conducted an observational population-based study of ankle fracture surgeries performed in Sweden between 2008 and 2022. Patients aged 15 years and above who underwent ankle fracture surgery were included in the analysis. Surgical procedures were identified using NOMESCO codes specific to ankle fractures. Demographic trends, surgical procedures and incidence rates were analyzed using descriptive statistics, incidence calculations and regression analyses. RESULTS: Women accounted for 55% of surgeries (p = 0.022), with a significant proportion (47%) occurring in individuals aged 65 and above. Although the overall incidence of ankle surgeries decreased by 6% (p = 0.008), notable age-specific trends emerged, including a decrease in surgeries among younger adults and an increase among the elderly. Plate and screw fixation remained the most commonly employed surgical technique, with a 21% increase in usage (p <
0.001), while the use of external fixation and intramedullary nailing increased significantly by 123% and 69%, respectively (both p <
0.001). Conversely, the use of cerclage and/or pin fixation decreased by 74% (p <
0.001) over the study period. CONCLUSIONS: Our study of open source data shows current trends in surgically treated ankle fractures in Sweden, highlighting a decreased incidence overall, notable shifts between age groups and several trends in surgical procedures. Despite limitations inherent to retrospective observational studies, such as the inability to establish causal relationships, our findings contribute to the understanding of ankle fracture management trends, highlighting areas for further investigation and improvement in orthopedic care.