Pelvis and lower extremity fractures related to 4-wheeled off-road vehicles: trends from the national electronic injury surveillance system database

Abstract Objective: This paper characterizes recent trends in pelvis and lower extremity orthopaedic injuries treated in US emergency departments from 2012 to 2021 associated with four-wheeled off-road vehicles (ORVs). Methods: The National Electronic Injury Surveillance System database was queried for ORV-related lower trunk and lower extremity injuries from 2012 to 2021. Injury totals and trends were analyzed descriptively, with a weighted analysis generalizing results to the US population. Results: A total of 1795 cases were analyzed, representing 71,506 lower extremity and pelvis injuries from 2012 to 2021. Adults (age ≥18) accounted for 47,342 injuries (45,036 fractures and 1643 dislocations), whereas pediatric (age <18) patients accounted for 24,164 (21,951 fractures and 1388 dislocations) injuries. Adult fractures most commonly involved the lower leg (14,560, 30.8%), ankle (9416, 19.9%), and pelvis/hip (7566, 16.0%). The commonest pediatric fractures were in the lower leg (7561, 31.2%), ankle (3498, 14.5%), and upper leg (3247, 13.4%). There was a notable increase in fractures after 2018, mainly because of rising ankle, knee, and pelvis fractures. From 2012 to 2021, there were 21,782 hospital admissions. Conclusion: ORV-related injuries are increasing in prevalence and severity as ORV use increases. Rates of lower extremity orthopaedic injuries, particularly ankle, knee, and pelvis fractures, have risen, especially since 2018. These data should inform the trauma community to promote awareness of ORV dangers and safety. Level of Evidence: IV.