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. 2025 Sep;20(6):861-870.
doi: 10.1177/15589447231219286. Epub 2024 Jan 24.

Upper Extremity Fractures in the Emergency Department: A Database Analysis of National Trends in the United States

Anthony L Karzon  1 , Ehab M Nazzal  2 , Hayden L Cooke  1 , Kevin Heo  1 , Onyinye Okonma  3 , Jacob Worden  4 , Zaamin Hussain  1 , Kevin C Chung  5 , Michael B Gottschalk  1 , Eric R Wagner  1
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Free PMC article

Upper Extremity Fractures in the Emergency Department: A Database Analysis of National Trends in the United States

Anthony L Karzon et al. Hand (N Y). 2025 Sep.
Free PMC article

Abstract

Background: Upper extremity (UE) fractures are a common reason for emergency department (ED) visits, but recent data on their epidemiology are lacking. This study aimed to describe the incidence, demographics, patient characteristics, and associated health care factors of UE fractures, hypothesizing that they would remain prevalent in the ED setting.

Methods: Using the Nationwide ED Sample database, patients presenting to the ED with UE fractures in 2016 were identified, and population estimates were used to calculate incidence rates. Data on insurance status, trauma designation, cost, and teaching status were analyzed.

Results: The study identified 2 118 568 patients with UE fractures, representing 1.5% of all ED visits in 2016. Men accounted for 54.2% of UE fractures, with phalangeal fractures being most common. Distal radius and/or ulna fractures were most common in women (30.4%). The greatest proportion of UE fractures (23.2%) occurred in patients aged 5 to 14 years (1195.5 per 100 000). Nontrauma centers were the most common treating institutions (50.4%), followed by level I (19.5%), II (15.3%), and III (12.8%) centers. The greatest proportion of fractures (38.3%) occurred in the southern United States. Emergency department cost of treatment was almost 2-fold in patients with open UE fractures compared with closed.

Conclusion: This study provides important epidemiological information on UE fractures in 2016. The incidence rate of UE fractures in the ED has remained high, with most occurring in the distal radius, phalanges, and clavicle. In addition, UE fractures were most common in younger patients, men, and those in the southern United States during the summer. These findings can be useful for health care providers and policymakers when evaluating and treating patients with UE fractures.

Keywords: emergency department fractures; epidemiology; upper extremity; upper extremity fracture incidence; upper extremity fractures.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: M.B.G. is a consultant for Acumed; receives institutional support from Arthrex, Acumed, and Skeletal Dynamics; and receives principal investigator research funding from Stryker. None are relevant to this article. E.R.W. receives consulting fees from Stryker, Wright Medical, Biomet, Acumed, and Osteoremedies and research support from Arthrex, Konica Minolta, and DJO. None are relevant to this article. The remaining authors report no conflicts of interest.

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