The Changing Landscape of Ankle Fractures in the Era of Electric Micromobility: A Systematic Review

Electric bicycles (e-bikes) and electric scooters (e-scooters) have been rapidly adopted in urban environments in the United Kingdom and various Western countries. This has introduced a new mechanism of injury in these environments. Whilst the initial research studies focused on head injuries, upper limb injuries and overall epidemiology, the specific patterns regarding lower limb orthopaedic injuries, especially ankle fractures, are not well defined. This systematic review aims to characterise ankle fracture patterns due to e-bike and e-scooter use and assess whether the incidence and severity have worsened since adopting these devices. We performed a systematic literature review in PubMed for articles published between 2015 and 2025. This timeframe was selected as micromobility adoption was uncommon prior to 2015. Our initial search yielded 83 studies; after screening and eligibility assessment, 11 studies were included for final analysis. From the studies, we were able to identify that there was a distinct injury pattern associated with e-scooters, i.e., isolated ankle rotational fractures from low-energy falls. Data from UK Government sources initially indicated that e-scooter users primarily experienced low-energy injuries, while e-bike users, although reported less frequently, seemed to suffer more high-energy fracture patterns due to higher speeds. However, recent data suggest that the frequency and severity of injuries from e-scooter accidents are increasing, with more cases exhibiting high-energy mechanisms. UK-specific data, though limited, align with global trends, indicating a significant and growing burden on Emergency Departments and Orthopaedic services, with a notable proportion of injuries requiring operative intervention. In comparative studies, e-bike crashes were less frequently linked to ankle fractures. All data indicate a sharp rise in overall micromobility injuries over recent years. Ankle fractures from electric micro-mobility devices represent a significant and evolving public health issue. While consistent with international findings, the current evidence from the UK is insufficient. There is a pressing need for prospective, multicentre studies and national registry data to define these injury patterns better and inform targeted public safety measures and orthopaedic preparedness.