Wrist fractures are among the most common upper extremity injuries. Despite their prevalence and significant societal and healthcare costs, long–term epidemiological data on national wrist fracture trends remain limited.

This retrospective study analyzed data from the National Electronic Injury Surveillance System (NEISS) and U.S. Census data to evaluate national trends in wrist fractures from 2004 to 2023. Utilizing weighted sampling techniques, incidence rates were calculated, and demographic patterns, causes, and differences between athletic and non–athletic injuries were assessed. Statistical analyses included regression models, chi–square tests, and injury proportion ratios (IPR).

Over the twenty-year study period, there were a reported 106,929 wrist fractures, representing 4,040,516 cases nationwide (95% CI: 3,414,316–4,666,716). The incidence declined significantly over the study period from 78.04 per 100,000 person–years in 2004 to 60.27 in 2023 (p < 0.05), representing a 22.7% decrease in overall wrist fracture incidence rates. Males aged 5–14 years showed the highest fracture rate (238.2 per 100,000), primarily driven by sports–related injuries such as bicycling, football, and skateboarding. Conversely, females aged ≥65 years had the highest risk of non–athletic fractures, often due to falls on stairs or floors. Nearly half (47.96%) of all wrist fractures were sports–related, with males three times more likely than females to sustain such injuries (OR: 3.05, p < 0.001).

This comprehensive analysis of wrist fracture trends over two decades reveals a significant decline in overall incidence, with notable demographic patterns. These findings underscore the importance of targeted prevention strategies, such as improving safety measures in youth sports and enhancing fall prevention programs for older adults, while highlighting the need for continued research to inform effective prevention and treatment strategies.