Approaches to the Management of Shotgun Injuries

Lm, Flint; Hm, Cryer; Da, Howard; Jd, Richardson

doi:10.1097/00005373-198405000-00008

Cited by 27 publications

(10 citation statements)

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“…Many reports, as confirmed here, also showed the highest incidence in the extremities [4][5][6]19], while others reported a preponderance of abdominal GSI [7]. The highest incidence of injuries involving high-velocity gunshots (47%) in Nigeria was from Lagos, the most industrialized part [18].…”

Section: Discussionsupporting

confidence: 69%

Epidemiology and Outcome of Gunshot Injuries in a Civilian Population in West Africa

Solagberu

2003

European Journal of Trauma

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Background and Objectives: Gunshot injuries (GSI) were first reported in West Africa following the Nigerian civil war of [1967][1968][1969][1970]. Recent wars within and around the West African subregion have further encouraged easy access to sophisticated and locally manufactured firearms. This report examines the epidemiology and management of GSI in an urban settlement in West Africa. Patients and Methods: GSI data was collected prospectively for 24 months beginning September 1999: age, sex, velocity of gunshot, circumstances of GSI, whether accidental or intentional, and by whom (self-inflicted, police, armed robbers, and others via riots and/or students' secret cult activities), region(s) affected, operative interventions, and outcome of care. Results: 107 GSI patients were seen, comprising 99 males and eight females (M : F ratio = 16.8 : 1), 79 of whom (73.8%) were analyzed comprising 71 males and eight females (M : F ratio = 9 : 1); mean age 29.9 ± 13.0 years (range 5-75 years). Intentional GSI occurred in 66 cases (83.6%) -45 from armed robbers (57.0%), the others from police gunshots, assaults, religious/communal riots, and cultists. No suicide-related GSI were recorded. Accidental GSI occurred in 13 (16.5%) -eight from hunters and five from the police. 16 of the 79 (20.3%) were high-velocity gunshots. The regions affected were extremities 29 (35.7%), multiple regions 23, chest twelve, abdomen eight, head six, and neck one. 13 deaths (16.5%) occurred, all before surgical intervention -twelve in the emergency room because of late reporting and lack of blood transfusion. Ten of the deaths (76.9%) resulted from gunshots to either the chest or abdomen. 27 patients (34.2%) were successfully treated, eleven of whom had operations, while the majority (39 patients, 49.4%) was discharged against medical advice to traditional healers for bullet extraction. Conclusion: Wars in West Africa have caused a high incidence of GSI in peace times through armed robbery. Suicide-related GSI is rare in Nigeria unlike in many developed countries. Only every fifth GSI is a result of a high-velocity gunshot. Mortality determinants are the region of GSI and injury-arrival time. The logistics in the emergency room leading to unacceptable deaths requires an overhaul. Half of GSI victims discharged themselves to native healers for extraction of pellets, portraying the beliefs of patients about GSI.

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Section: Discussionsupporting

confidence: 69%

Epidemiology and Outcome of Gunshot Injuries in a Civilian Population in West Africa

Solagberu

2003

European Journal of Trauma

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“…Shotgun wounds range from injuries with point blank blasts being very destructive, and longer range blasts rarely causing significant deep tissue damage [1,5]. Shotgun blasts also have the potential to affect multiple systems [6]. Although injuries from gunshot wounds are increasingly managed nonoperatively [7][8][9][10], we hypothesized that since the energy dissipation is different between gunshot and shotgun wounds, their injury patterns and treatment options should also be different.…”

Section: Discussionmentioning

confidence: 99%

“…Severity of injury was measured using the Injury Severity Scale (ISS) and the Revised Trauma Score (RTS). Patients were grouped as having a mild (1)(2)(3)(4)(5)(6)(7)(8), moderate (9)(10)(11)(12)(13)(14)(15), severe (16)(17)(18)(19)(20)(21)(22)(23)(24), or most severe (>24) injury based on the ISS. The RTS was calculated from the first set of vitals obtained and analyzed in continuum.…”

Section: Methodsmentioning

confidence: 99%

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Despite the Increasing Use of Nonoperative Management of Firearm Trauma, Shotgun Injuries Still Require Aggressive Operative Management

Dozier

Miranda

Kwan

et al. 2009

Journal of Surgical Research

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“…In summary, even if the fracture, and the injury as a whole, has been adequately treated, including appropriate bone fragment reduction and immobilization by means of external fixators according to the dictates of wartime medical doctrine, together with appropriate physical therapy and graduated weight-bearing exercises, quite a long period of time and a considerable amount of patience are needed before the first signs of secondary bone healing, i.e., healing with callus formation, are observed [6,15,18]. Sometimes it takes as long as 3-4 months for the first signs of callus formation to appear [16].…”

Section: War Injuriesmentioning

confidence: 99%

War injuries to the bone and joint system: reconstructive surgery

Koržinek

1994

Arch Orthop Trauma Surg

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Reconstructive bone and joint surgery in war is discussed. Bone and joint injuries account for over 70% of all injuries, 30% including a fracture. They pose a serious medical, surgical, and public health problem. The methods described aim to restore full function to the injured extremity. War injuries incorporate severe circulatory disorders and severe soft tissue and bacterial contamination. The war surgeon is faced with defectively healed or unhealed fractures, bone and tissue defects, joint injuries, traumatic amputations, large joint contractures, and infections. Clinically, external fixators, the Ilizarov method, antibiotic prophylaxis, and a new antiseptic agent have proved highly beneficial.

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Approaches to the Management of Shotgun Injuries

Cited by 27 publications

References 0 publications

Epidemiology and Outcome of Gunshot Injuries in a Civilian Population in West Africa

Epidemiology and Outcome of Gunshot Injuries in a Civilian Population in West Africa

Despite the Increasing Use of Nonoperative Management of Firearm Trauma, Shotgun Injuries Still Require Aggressive Operative Management

War injuries to the bone and joint system: reconstructive surgery

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