Machete-related orthopedic and extremity injuries treated in U.S. emergency departments, 2005–2024

Machetes are widely accessible in the U.S. but understudied in trauma epidemiology. This study focuses specifically on orthopedic and extremity-related machete injuries, which are most reliably captured in national surveillance databases. We describe national trends, demographics, and injury patterns for machete-related extremity injuries presenting to U.S. emergency departments (EDs). Using data from the National Electronic Injury Surveillance System (NEISS) from 2005 to 2024, we identified machete-related injuries through narrative searches (including common misspellings) and manual review. Weighted analyses accounted for NEISS’s complex sampling design. We assessed national incidence, patient demographics, injury diagnoses, anatomical distribution, laterality, and disposition. We identified 1,525 unique cases which corresponds to an estimated 73,918 (95% CI: 56,922 − 90,913) national ED presentations over 20 years. Injuries peaked in 2017 and 2020, occurred primarily on weekends and in summer months, and were most common among men aged 18–34. Lacerations accounted for 91.8% of all injuries, fractures (2.1%) and amputations/avulsions (2.4%) were less common. Fingers represented 37.9% of all injuries with the thumb and index finger most frequently affected. Left-sided injuries predominated in the upper extremity. Most patients (95.6%) were treated and released, and 3.0% required admission or transfer. Narrative review revealed underreporting of complex injuries (e.g., tendon, nerve, vascular injuries). Machete-related injuries in the U.S. represent a rare but persistent source of ED visits with meaningful morbidity especially to the left upper extremity. Findings should be interpreted as descriptive and hypothesis-generating. Prevention efforts focused on safe tool use, protective equipment, and targeted education may help reduce injury risk.