Finger fractures are among the most common upper extremity injuries, with significant functional and socioeconomic implications. While prior studies have described the general epidemiology of finger fractures, there is limited data on longitudinal trends, digit-specific patterns, and differences in injury mechanisms by demographic groups in the United States.

A retrospective analysis was performed using the National Electronic Injury Surveillance System (NEISS) database to estimate national trends in finger fracture incidence from 2004 to 2023. Cases were identified using specific diagnosis and body part codes, with narrative keyword filtering to determine the affected digit. Demographic variables, injury mechanisms, and annual incidence rates were analyzed. Trends were assessed using linear regression, and differences between groups were evaluated with Odds Ratios and Injury Proportion Ratios.

A total of 109,317 finger fractures were reported over the twenty-year study period, representing a nationally estimated 3,693,924 finger fractures. The average annual incidence was 59.0 per 100,000 person-years. Males accounted for 65.4% of total cases, with a male-to-female incidence ratio of approximately 2:1. The thumb (26.42%) and little finger (26.15%) were the most frequently fractured digits, followed by the ring finger (15.29%), middle finger (14.53%), and index finger (12.06%). The most common causes were football (11.7%), basketball (11.5%), and doors (9.8%). There was a 46% decline in emergency department finger fracture rates from 2004 to 2023 (p < .01), driven primarily by reductions in the 0–18 and 19–40 age groups. Rates in adults over 40 remained stable.

This comprehensive, longitudinal analysis demonstrates a significant decline in emergency department finger fracture incidence in the United States over the past two decades, with notable demographic and mechanistic patterns. These findings highlight the importance of age- and activity-specific prevention strategies, continued surveillance, and targeted interventions to further reduce the burden of finger fractures, particularly among vulnerable populations such as older adults and children.