Background. Violence and injuries are a significant global public health concern, and have a substantial emotional, physical and economic impact on society. In South Africa (SA), the Western Cape Injury Mortality Profile shows that homicides increased from 38 deaths per 100 000 in 2010 to 52 deaths per 100 000 in 2016. This increase is directly related to an increase in firearm-related homicides, which doubled from 2010 to 2016. Previous research estimated the average cost per gunshot wound (GSW)-related orthopaedic patient at USD2 940. GSWrelated patient numbers as well as treatment costs have escalated exponentially over the past few years. Objectives. To calculate the financial costs involved in managing gunshot-related orthopaedic injuries both surgically and non-surgically at a tertiary centre in SA. Methods. After ethics approval, a retrospective review of all GSW patients seen in the emergency unit at Tygerberg Hospital in 2017 was undertaken. Patient records yielded data on the following parameters: injury site and characteristics, imaging modalities, orthopaedic management, hospital admission and duration of hospitalisation, theatre episodes, orthopaedic implants and blood products administered. Cost analysis was performed using this information. Results. A total of 389 patients (360 male and 29 female), average age (range, standard deviation) 28 (3 -69, 9.50) years, were treated during the study period. Patient records identified a total of 449 orthopaedic injuries. A total of 187 patients were admitted, with 175 requiring surgical fixation. The conservatively calculated cost of managing this patient group was ZAR10 227 503. The average management cost per patient was ZAR26 292, with an average of ZAR46 670 per case requiring surgical management and ZAR8 810 for non-surgical cases (the average USD-ZAR exchange rate in 2017 was USD1-ZAR13.30). Conclusions. The total cost of managing 389 patients with gunshot-related orthopaedic injuries at a tertiary hospital was ZAR10 227 503. Improved understanding of these costs will help the healthcare system better prioritise orthopaedic trauma funding and training and highlights the urgent need for cost-saving measures, specifically primary prevention initiatives.
BACKGROUND: The aim of this retrospective longitudinal study was to describe the overall burden and outcomes of surgically managed gunshot tibia fractures at a major trauma centre. Secondary objectives were to identify possible risk factors for complications including non-union and infection and to highlight any differences in outcomes between treatment modalities METHODS: All consecutive patients who sustained gunshot injuries to the tibia between January 2014 and December 2017 including children and multiple gunshots injuries were considered for inclusion. Information related to patient demographics, injury characteristics, treatment information and treatment outcomes with respect to rate of fracture union and occurrence of infection were obtained from patient records. All patients with insufficient medical records were excluded RESULTS: The records of 197 patients who sustained gunshot tibia fractures were reviewed. The mean follow-up was 4.1 months (interquartile range [IQR] 2.5-6.8). The majority of cases were young males (89%) with a mean age of 29.2±10.2 years. Extra-articular diaphyseal fractures were observed in the majority of cases (91%). Definitive treatment included formal debridement in theatre and plaster cast immobilisation (44%), intramedullary nail fixation (27%), circular external fixation (22%) and plate fixation (7%). The study revealed an overall fracture-related infection (FRI) rate of 11% and bone union rate of 91%. Circular external fixation showed the lowest fracture union rate (86%) and highest FRI rate (21%) of the modalities included in this study. No associations between independent risk factors and presence of complications were identified CONCLUSION: The study reports encouraging outcomes for tibia fractures caused by civilian gunshot injuries. Various definitive surgical stabilisation techniques showed high proportions of union and low burden of FRI Level of evidence: Level 4 Keywords: tibia, gunshot, fracture, outcome
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