Gun violence is a public health crisis. In 2020, America had the highest number of deaths due to gun violence on record. Gun violence and stabbings were the second and fifth causes of violence-related deaths in the United States, respectively. There were 45,222 gun deaths in the United States, with suicide comprising 54% and homicides comprising 43% of those deaths. While 30% of American adults report owning a gun, 52% of non-gun owners could see themselves owning a gun in the future. Urban areas are particularly affected by gun violence. In 2015, 81% of the 12,979 firearm homicides that occurred in the US occurred in cities. In the urban trauma setting, penetrating trauma disproportionately impacts the pre-existing violence in these areas. During the COVID-19 global pandemic, emergency departments have seen a rise in trauma admissions. This exacerbation of violence may correlate with the economic devastation caused by the COVID-19 pandemic. Higher poverty rates in these areas contribute to the crime and increased prevalence of penetrating injury. This upsurge of trauma is particularly salient in urban hospital settings, where there is a concentration of violent injuries.

Traumatic orthopedic injuries in the elderly patient present both a medical and surgical challenge. This growing population requires management tailored to specific patient needs and particular attention to bone quality and soft tissue management to avoid complications. Injury treatment is dependent on host factors, injury factors, and other special considerations in order to optimize outcome. The goal of treatment in the elderly patient is to allow for return to preinjury functional status, obtain fracture healing, and restore mobility. This chapter will focus on the treatment of some of the most common musculoskeletal injuries encountered in the elderly, including proximal humerus fractures, wrist fractures, hip fractures, ankle fractures, and vertebral compression fractures.