Background: Firearm injuries are associated with substantial emotional, physical and financial burden on community and hospital resources leads to profound morbidity. It is a global public health problem and pose therapeutic challenges to surgeons. Proper management of firearm wounds requires a working knowledge of physical factors involved in the creation of such injuries. Regional variations of the parameters of medico legal aspects of firearm injuries are still lacking. Objective is to analyse pattern of firearm injuries managed at rural tertiary hospital.Methods: All firearm injury cases brought to the emergency department of Hospital, from January 2016 to December 2016 were included in the study.Results: In this study 108 (83.7%) victims were males and 21 (16.3%) were female. Most common age group victimized was 20-29 year (33.3%). Most cases occurred in winter season.113 cases (87.3%) victim were unemployed.81 cases (62.8%) had below intermediate education. 110 (85.3%) cases were of homicidal motive. Shotgun/ ‘kattas’ outnumbered the rifled firearm injuries (109) cases (84.5%). Trunk was involved in 45 cases (34.8%) and lower extremity in (32.6%) 42 cases,) Exit wound found in 93(72.2%) cases only. The fatality rate was 3.9% (5 cases). . Wound debridement was performed for 48 cases (37.2%) of patients, while emergency exploration was done for 30 cases (23.3%). The hospital stay of 49 cases (37.9%) of patients was more than one week. 111 cases (86.1%) were discharged.Conclusions: Addressing the root causes of violence such as poverty, unemployment, substance abuse will reduce the incidence of firearm injuries in our environment. Establishment of efficient emergency health care services for pre-hospital care and effective ambulance system for rapid transport of injured victims to hospital will reduce morbidity and mortality. Management requires knowledge ATLS protocols, mode, presentation and ballistic of firearm. Authorities issuing license for possession of firearms need to be more strict and vigilant.
Introduction:The severe long bone defects usually follow high-energy trauma and are often associated with a significant soft-tissue injury. The goal of management of these open long bone defects is to provide stable fixation with maintenance of limb length and soft-tissue coverage. The purpose of this article is to present the clinic-radiological outcome, complications and treatment of post-traumatic long bone defect with vascularised fibula transfer.Materials and Methods:Retrospective records of 28 patients were analysed who presented with post-traumatic long bone defects and in whom reconstruction with vascularised free fibula was done. Demographic data were recorded and clinical and radiological assessment was done.Results:Out of 28 patients in whom vascularised free fibula transfer was carried out three flaps were lost while non-union occur in three patients. Three patients developed a stress fracture of transferred free fibula in the post-operative period. Few of the patients experienced some problems in the donor leg; however, all of them improved in subsequent follow-up.Discussion:It is clearly evident from this study that timing of surgery plays an important role in the micro-vascular reconstruction in trauma cases. All the complication like flap loss, non-union or delayed union occur in patients in whom reconstruction was delayed.Conclusion:The free vascularised fibula graft is a viable method for the reconstruction of skeletal defects of more than 6 cm, especially in cases of scarred and avascular recipient sites or in patients with combined bone and soft-tissue defects. Results are best when the reconstruction is done within 1 week of trauma.
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