Background Little is known regarding risk factors specific to pediatric upper extremity firearm injuries.The purpose of this study is to evaluate pediatric patients treated for these injuries to identify at-risk populations and recurring mechanisms of injury.Methods A 20-year retrospective review was conducted.Patients 17 years of age and younger,with upper extremity injuries related to a firearm,were included.Analysis involved Fisher\'s exact and Chi-square tests.Results One hundred and eighty patients were included.The mean age was 12.04± 4.3 years.Most included patients were male (85％).Interestingly,females were more frequently victims of assault (P =0.03),and males were more frequently injured due to accidental discharge (P ＜ 0.001).The most affected race/ethnicity was White-not Hispanic or Latino (48％).The hand was the most frequent location injured (31％) and was more likely to be accidental than proximal injuries (P =0.003).Air rifles were the most common firearm type used (56％).Pistols were implicated in 47 (26％) cases,rifles in 17 (9％),and shotguns in 10 (6％).Ninety-nine (55％) patients had procedures in the operating room.The most frequent procedure was foreign body removal (55％).Conclusions Risk factors such as male sex,White-not Hispanic or Latino race/ethnicity,and adolescent age were attributed to increased risk for injury.Male sex was associated with increased risk of injury by accidental discharge and female sex with intentional assault.Air rifles were the most common firearm type overall,although female sex was associated with increased risk for injury by powder weapon.