Effect of COVID-19 on orthopedic injuries due to firearm violence

Background: This analysis explores changes in firearm-related orthopedic injuries surrounding the COVID-19 pandemic. Methods: The National Electronic Injury Surveillance System database was queried from 1993 to 2022, summarized by injuries related to firearms, time-period relative to the COVID-19 pandemic (before: 01/01/1993–03/12/2020; after: 03/13/2020–12/31/2022), and orthopedic injury status. Descriptive statistics were summarized, and Pearson's chi-squared tests to assess categorical differences. Independent samples t-tests compared means between groups. Statistical analyses were conducted using IBM SPSS Statistics Version 29. P < 0.05 was significant. Results: 133,778 firearm-related cases were included (average age 28.2 years; 86.0 % males). Orthopedic injuries made up 10.8 %. Fractures were the most common (10.1 % of total injuries). Orthopedic injuries accounted for 8.9 % of injuries pre-COVID vs. 20.4 % during the COVID period, representing a 2.34-fold increase. There was a slight decrease in the proportion of fractures occurring at home after COVID (41.3 % vs. 36.7 %) and fractures occurring on public properties increased (24.7 %–34.3 %; χ² = 71.38, p < 0.001). Injuries sustained by black individuals increased from 54.4 % to 69.0 % after COVID. Similar trends were seen in the American Indian (0.002 %–0.3 %) and Asian (0.0 %–0.7 %) populations (χ² = 2665.70, p < 0.001). The proportion of Hispanic individuals sustaining injuries increased from 8.4 % pre-COVID to 10.7 % post-COVID (χ² = 91.46, p < 0.001). Within orthopedic-related injuries, handgun involvement increased from 72.7 % to 88.5 % during COVID (χ² = 117.68, p < 0.001), as did fractures related to handguns (77.2 %–89.5 %; χ² = 75.46, p < 0.001). After COVID, there was a decrease in self-inflicted orthopedic injuries (40.9 %–31.9 %). There was a significant decrease in the proportion of individuals being treated at small hospitals from pre-to post-COVID (6.5 % vs 3.1 %, χ² = 411.43, p < 0.001). Of orthopedic injuries, 56.3 % resulted in hospitalization. Conclusion: Orthopedic injuries and specifically fractures increased during COVID, representing an increased burden of care specifically in larger hospital systems, which disproportionally affected women and non-white patients. Level of evidence: Level III; retrospective cohort study.