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Trends in Pediatric Orthopaedic Firearm Injuries: A 28-Year National Representative Database Review.

Sarah Lu1, Shane Ross1, Christopher J Williams1

  • 1Lerner Children's Pavilion, Hospital for Special Surgery, New York, NY, USA.

Journal of the Pediatric Orthopaedic Society of North America
|April 20, 2026
PubMed
Summary

Pediatric firearm-related orthopaedic injuries declined from 1993-2021, yet unintentional and self-inflicted cases remain concerning. Greater firearm safety education is crucial for preventing these injuries in children and adolescents.

Keywords:
EpidemiologyFirearmFirearm injuryPediatric othopaedics

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Area of Science:

  • Public Health
  • Orthopaedic Surgery
  • Trauma Surgery

Background:

  • Firearm-related injuries represent a significant public health concern in the U.S., causing numerous pediatric deaths and nonfatal orthopaedic injuries.
  • Understanding trends in pediatric orthopaedic firearm injuries is critical for developing targeted prevention strategies.

Purpose of the Study:

  • To analyze trends and characteristics of pediatric orthopaedic injuries related to firearms, encompassing both fatal and nonfatal cases.
  • To identify demographic, injury, and intent patterns associated with firearm-related orthopaedic trauma in children and adolescents.

Main Methods:

  • Retrospective analysis of the Firearm Injury Surveillance Study (FISS) database from 1993 to 2021.
  • Inclusion of patients aged 0-18 years with orthopaedic injuries involving firearms.
  • Statistical analysis using simple linear regressions to assess temporal trends.

Main Results:

  • An overall declining trend in pediatric orthopaedic firearm injuries was observed from 1993 to 2021, with noted spikes in 2012 and 2020.
  • Males aged 15-18 years constituted the majority of cases (80%), with over half of injuries being self-inflicted (59.5%) and unintentional (69%).
  • Fractures were the most common injury type (72%), frequently affecting the finger, hand, and foot. Over 30% of injuries were fatal, with unintentional incidents comprising 88.2% of fatalities.

Conclusions:

  • Despite an overall decrease, pediatric firearm-related orthopaedic injuries, particularly unintentional and self-inflicted ones, persist.
  • Adolescent males are disproportionately affected, highlighting the need for enhanced firearm safety awareness and education programs.
  • The findings underscore the ongoing public health challenge posed by firearm violence and the importance of targeted interventions.