Ballistic (i.e., gunshot-induced) fractures are commonly treated in large urban medical centers and military settings. Ballistic fractures can present unique treatment challenges as they may be associated with high rates of complications such as superficial and deep infection, vascular and neurologic injury, compartment syndrome, and fracture nonunion [1], [2], [3], [4], [5]. However, our understanding of these types of fractures is limited by a relatively scarce body of published literature consisting mostly of retrospective studies and there is limited evidence regarding the optimal management of ballistic fractures [6,7]. As such, there remains variation among surgeons in the specific treatment strategies employed for these injuries [8].

At the same time, there is concern that gun-related violence is increasing both in the United States (US) and in other countries worldwide [9], [10], [11], [12], [13]. A recent study of nationwide US Emergency Department (ED) data (from the years 2009-2017) demonstrated that firearm-related injuries have been increasing among certain groups in the US in recent years [14]. Similar findings have been observed in Europe [10]. Furthermore, data suggests that the recent global pandemic has only exacerbated these trends [11,15].

With an increasing number of gun-related injuries occurring in the US, it is possible that the number of ballistic fractures treated in the US is also increasing. However, there are few contemporary studies on the topic of ballistic fracture epidemiology, and there currently exist no large-scale, population-based studies assessing the incidence and national burden of ballistic fractures specifically in the US. The purpose of this descriptive epidemiology study, therefore, was to investigate the incidence and demographics of patients with ballistic fractures in the US over the last two decades using a nationally representative dataset. A better understanding of the epidemiology of ballistic fractures may help to enable surgeons, other healthcare and emergency service personnel, policymakers, and trauma centers to plan for future need.