The study, published in the Journal of Emergency and Disaster Medicine, drew on two decades of data from the National Electronic Injury Surveillance System, or NEISS, a probability sample of 100 hospitals operated by the United States Consumer Product Safety Commission that monitors emergency department visits involving consumer products. Because NEISS samples roughly 100 hospitals out of more than 5,000 with emergency departments, each recorded encounter carries a statistical weight that allows researchers to estimate national incidence. The research team searched the database from 2005 through 2024, casting a wide net that included common misspellings such as machette and masheti, and then manually reviewed every candidate case to exclude encounters in which the word appeared but the machete was not the true mechanism of injury. That screening process reduced an initial pool of 1,762 cases to 1,525 verified machete-related injuries, and the weighted analysis transformed those records into a striking national estimate: approximately 73,918 emergency department presentations over 20 years, with a 95 percent confidence interval spanning roughly 56,900 to 90,900 visits.

The demographic profile of the injured population is remarkably distinct from that of other consumer product injuries. Nearly 91 percent of the cases involved men, and young adults between 18 and 34 years old accounted for more than a third of all injuries, a pattern the researchers attribute to higher occupational and recreational exposure in this group. At the opposite extreme, female children aged 0 to 4 were almost entirely spared, with only a single case identified across the entire 20-year period. Race was recorded for about 69 percent of encounters, among which 81.8 percent of patients were White, 8.0 percent Black, 7.4 percent multiracial, and the remainder distributed across other categories. Review of the free-text injury narratives suggested that many of these accidents occurred during routine activities such as yard work, vegetation clearing, or tool maintenance, implying that a substantial proportion were unintentional rather than the result of assaults, though the study’s authors caution that intent cannot be reliably determined from brief surveillance narratives.

Temporal patterns tell an equally vivid story. Injuries clustered on weekends, with Saturdays accounting for 20.9 percent of cases and Sundays 18.0 percent, and they surged during the warm months between May and September, which together produced 58.4 percent of all cases over the study period. Annual incidence peaked in 2017 and again in 2020, with the highest rate per 100,000 recorded emergency department visits reaching 36 in 2020. The 2020 spike is particularly suggestive: the COVID-19 pandemic drove many Americans outdoors, and other research has documented increases in outdoor recreational injuries during the summer of 2020. The authors propose that more people were wielding machetes for landscaping, trail clearing, and campsite maintenance during lockdowns, though they emphasize that such interpretations remain hypothesis-generating rather than definitive.

When it comes to the anatomy of the injuries themselves, the numbers are both precise and sobering. Lacerations dominated, accounting for 91.8 percent of all primary diagnoses, which is unsurprising given the machete’s sharp design. Fractures made up 2.1 percent of cases, and amputations and avulsions together represented 2.4 percent. Fingers were the single most commonly injured body part, comprising 37.9 percent of all injuries, an estimated 28,000 national cases over two decades, with the index finger involved in 11.2 percent of injuries and the thumb in 9.2 percent. The lower leg, excluding knee and ankle, accounted for 17.9 percent of injuries, and the hand itself, exclusive of digits, another 15.7 percent. Compared with other sharp tool injuries, which tend to concentrate in the hands, machete wounds appear more distributed across the body, a pattern the researchers liken to chainsaw trauma. They speculate that the follow-through of a heavy swing in an outdoor setting can bring the blade into unintended contact with the legs, though the surveillance data cannot confirm this mechanism directly.

One of the study’s most intriguing findings concerns laterality. Among the 859 cases, or 57.7 percent, in which narratives described which side of the body was hurt, left-sided injuries predominated at 59.0 percent versus 40.7 percent right-sided, with only two bilateral encounters. The skew was concentrated entirely in the upper extremities: left-sided hand and finger injuries occurred 62.3 percent of the time, left wrist injuries 62.5 percent, and left forearm injuries a striking 72.3 percent. Lower leg injuries, by contrast, were almost perfectly symmetrical, split 50.7 percent left to 49.3 percent right. The pattern mirrors prior literature on sharp tool trauma and is commonly attributed to the involvement of the non-dominant hand, which typically holds or stabilizes the material being cut. Because NEISS does not record hand dominance, the authors note that this explanation, while plausible, remains speculative.

Perhaps the study’s most methodologically valuable contribution is its demonstration of what structured surveillance coding misses. NEISS permits only a single primary diagnosis per encounter, so when a machete sliced through skin, tendon, nerve, and artery simultaneously, the coded diagnosis might simply read laceration. Narrative review uncovered 32 cases in which tendon, nerve, or arterial injuries were described in the text yet coded only as lacerations, along with 28 cases documenting flexor or extensor tendon involvement despite the absence of a tendon injury code in the system. The clinical significance of these hidden injuries is underscored by the disposition data: 48 cases required hospital admission for further management, eight more were treated and transferred to other facilities, and 3.0 percent of all patients overall required admission or transfer. Most patients, 95.6 percent, were treated and released, and a small 1.4 percent left against medical advice. No fatalities appeared in the dataset, but the depth and complexity of the tissue damage documented in the narratives make clear that these are far from trivial wounds.

The authors are candid about the limitations inherent in their approach. NEISS is a stratified probability sample, and rare injury mechanisms like machete trauma are especially vulnerable to sampling variability; a single hospital in a warm-weather agricultural state entering or leaving the surveillance network could sharply shift the national estimate for a given year. Annual fluctuations should therefore be read cautiously. The database also does not directly code injury intent, hand dominance, or long-term outcomes, leaving several of the study’s interpretations necessarily descriptive. Yet these constraints do not diminish the central finding that machete injuries constitute a persistent and nontrivial burden on American emergency care, one that has received almost no systematic attention until now.

The findings also point toward concrete prevention strategies. The overwhelming predominance of hand and finger injuries supports educational campaigns emphasizing proper grip, cutting technique, and situational awareness. The frequency of severe lacerations, fractures, and amputations argues for cut-resistant gloves and lower-extremity protective equipment, particularly for occupational and recreational users. Retailers and manufacturers could contribute through improved safety labeling and user guidance, much as has been done for chainsaws and other power tools, and community and workplace programs could reinforce safe tool handling and secure storage among high-risk groups such as young adult men and outdoor workers. Hospital planners, meanwhile, might use the weekend and summer peaks to anticipate demand for hand surgery and trauma resources.

Taken together, the study transforms an anecdote-driven topic into a quantifiable public health concern and showcases the power of narrative-enhanced surveillance for characterizing complex extremity trauma. Nearly 74,000 emergency department visits over two decades is a small number relative to the totality of American injuries, but each represents a patient whose grip, swing, or footing failed for a moment with a two-foot blade in hand. The researchers call for continued national surveillance, investigations into long-term functional outcomes and disability after these injuries, analysis of violence-related machete trauma using registries and law enforcement data, and evaluation of educational interventions for safe tool use. For a tool so widely available and so rarely studied, the message of the data is simple: the machete deserves more respect, and more attention, than the injury statistics have historically allowed.

Subject of Research: National epidemiology of machete-related orthopedic and extremity injuries treated in U.S. emergency departments

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

Article References: Chinthagada, J. E., Kin, C. C., Bisesi, B. T., Gibson, M. B., & Sanford, C. G. (2026). Machete-related orthopedic and extremity injuries treated in U.S. emergency departments, 2005–2024. Journal of Emergency and Disaster Medicine, 2(1), Article 6. https://doi.org/10.1007/s44467-026-00009-w

Image Credits: AI Generated

DOI: 10.1007/s44467-026-00009-w

Keywords: machete injuries, trauma epidemiology, NEISS, emergency departments, orthopedic trauma, hand injuries, lacerations, upper extremity, injury surveillance, injury prevention, amputation, public health

The research, published in the Journal of Medical and Biological Engineering by a team from National Yang Ming Chiao Tung University and Taichung Veterans General Hospital in Taiwan, tackles a problem that has resisted a series of high-tech fixes. Electromagnetic navigation systems, laser-guided targeting devices, and mixed-reality platforms have all been proposed to reduce reliance on the C-arm fluoroscope, yet none has achieved widespread adoption. Each brings drawbacks: electromagnetic systems can be confused by the metal instruments surrounding them, laser techniques require clear lines of sight that soft tissue can block, and mixed-reality systems add cost, complexity, and a steep learning curve to busy trauma workflows. None of these approaches, the authors note, reliably handles dynamic distal locking holes, which are elongated or grooved holes deliberately designed to allow angular variability, typically up to plus or minus fifteen degrees, so that controlled axial micromotion can stimulate callus formation and speed healing.

The new system pairs two components. The first is the intramedullary endo-transilluminating device, abbreviated iMET, which is placed inside the medullary canal and projects a visible point of light through the nail’s distal screw hole onto the bone surface, marking the exact entry site for the screw without any imaging. The concept builds on earlier work by the group, which previously described the iMET device as a means of reducing radiation exposure during interlocking procedures. The second component is a cannulated boring screw, a hollow, self-drilling screw with a five-millimeter tip that matches the diameter of the screw body. A guidewire passes through the screw’s hollow core, allowing the surgeon to drill and insert the locking screw in one continuous step rather than switching between drill, tap, and screwdriver. The design eliminates separate reaming and tapping, and it remains compatible with standard orthopedic guidewires, electric drill bits, and cannulated screwdrivers.

To test whether the concept actually works, the team conducted an in vitro feasibility study using five porcine femurs harvested from eight- to twelve-month-old Taiwan Taoyuan Black pigs obtained post-mortem from a licensed abattoir, meaning no live animals were involved and no animal care committee approval was required. Porcine long bones were chosen because their cortical structure, bone density, and medullary canal geometry closely resemble those of human long bones, making them a widely accepted model for preliminary biomechanical and procedural testing. The specimens were stored at minus eighteen degrees Celsius, thawed in a controlled water bath, and stripped of all muscle, fat, and bone marrow to create a standardized testing environment. A standard 170-millimeter-long, 10-millimeter-diameter intramedullary nail was then used with five hexagonal hollow drill screws measuring 38.1 millimeters in length, with a 12.5-millimeter head, a 5.5-millimeter body diameter, and a 1.2-millimeter hollow channel.

The experimental protocol was deliberately simple. Each femur was clamped horizontally to the table, the marrow was removed, and the cavity dimensions were recorded. A three-millimeter iMET positioning needle, held by a plastic clamp, projected a visible light point through the nail’s four-millimeter screw hole after a 180-degree rotation, marking both sides of the bone at the target angle. The team tested four locking configurations across the five specimens: 60 degrees, 45 degrees, 15 degrees, and 90 degrees, with the 90-degree configuration tested twice. After marking, drilling was performed with a six-millimeter bit, a 1.0-millimeter orthopedic guidewire was inserted through the hole at the specified angle, the cannulated screw was advanced over the wire, tightened with a hexagonal screwdriver, and the wire was withdrawn. Screw position and angle were verified with a protractor and calipers, and the nail was gently shaken to confirm stable fixation. Procedural time was divided into three stages, iMET positioning, drilling, and screw locking, each with defined start and end points.

The results were striking, even allowing for the idealized setting. Successful distal locking was achieved in every specimen at every tested angle, with no repeated attempts required. The mean total locking time was 46.8 seconds with a standard deviation of 16.5 seconds, and individual procedures ranged from 27 to 68 seconds. The 90-degree configuration proved fastest, requiring only 27 to 28 seconds, while the 60-degree configuration took the longest at 68 seconds. For context, the researchers compared these figures against historically reported data for conventional fluoroscopy-guided distal locking, which averages 246 seconds with a standard deviation of 108 seconds, roughly five times longer than the new technique. No ionizing radiation was used at any point during any procedure. The authors stress that this comparison relies on historical benchmarks rather than a concurrently tested control group, so the time savings should be read as a promising trend rather than a definitive causal result.

What may matter as much as raw speed is the consistency of the workflow across angles. The sequential process of optical positioning, guidewire-assisted drilling, and cannulated screw locking remained essentially unchanged whether the target hole was oriented at 15 degrees or 90 degrees, suggesting that multi-angle alignment does not degrade procedural efficiency. The authors argue that this flattening of the learning curve could be particularly valuable in time-sensitive trauma surgery, where long operations carry their own risks. They also emphasize that the system represents an integrated targeting-and-fixation workflow rather than a navigation aid bolted onto an existing procedure: the optical device solves localization, and the boring screw solves fixation, together addressing the entire locking problem rather than a single component of it.

The study’s limitations are candid and substantial. The work was performed on cleaned porcine bones without soft tissue, an idealized environment that cannot reproduce the muscle obstruction, bleeding, and patient-to-patient anatomical variation of a real operating room, all of which would likely increase procedural times. The sample of five specimens is too small for formal inferential statistics, which the authors acknowledge would be underpowered, so all data are presented descriptively. All procedures were performed by a single operator to minimize inter-operator variability, and accuracy was assessed procedurally, defined as successful alignment of the screw trajectory with the distal hole, proper screw engagement, and stable fixation confirmed by manual testing, rather than by independent radiographic measurement. Long-term biomechanical stability under cyclical loading has not yet been verified, and the comparison against fluoroscopy inherits all the confounding factors of historical data.

Those caveats frame what comes next. The team plans cadaveric studies with soft tissue intact, larger sample sizes, concurrent control groups, and rigorous biomechanical testing to establish whether the technique holds up under realistic surgical conditions. If those validations succeed, the implications could extend beyond a single procedure. Cumulative radiation exposure is a growing concern in high-volume trauma centers, where surgeons and staff undergo repeated fluoroscopic exposure across hundreds of cases, and recent research has even documented molecular biomarkers of X-ray damage in trauma surgeons. A distal locking method that eliminates the fluoroscope entirely, works across the angular range that dynamic holes demand, uses instruments compatible with standard surgical toolkits, and completes the job in under a minute would address several persistent pain points at once. For now, the study stands as a carefully hedged but genuinely intriguing proof of concept: inside the controlled confines of a laboratory, a light shone through a metal tube and a screw that drills itself proved faster, safer, and simpler than decades of X-ray-guided guesswork.

Subject of Research: A radiation-free optical targeting method with a cannulated boring screw for multi-angle distal locking in intramedullary nailing, tested in porcine femurs.

Article Title: Advancing Intramedullary Nailing: A Novel Radiation-Free Multi-Angle Targeting Method for Dynamic Distal Locking Screw Holes: A Technical Feasibility Study

Article References: Chiang, T.-L., Shih, C.-W., Lin, Y.-T., Lu, H.-T., Hsu, Y.-F., Chen, K.-H., & Chu, W.-C. (2026). Advancing Intramedullary Nailing: A Novel Radiation-Free Multi-Angle Targeting Method for Dynamic Distal Locking Screw Holes: A Technical Feasibility Study. Journal of Medical and Biological Engineering. https://doi.org/10.1007/s40846-026-01054-6

Image Credits: AI Generated

DOI: 10.1007/s40846-026-01054-6

Keywords: intramedullary nailing, distal locking, radiation-free surgery, optical guidance, cannulated screw, fluoroscopy reduction, dynamic locking holes, orthopedic trauma, porcine femur model, surgical navigation, iMET device, feasibility study