Mechanism matters: A 10-year experience of ballistic injuries of the upper extremity

Handel, Amelia C. Van; Shim, Kevin G.; Brown, Danielle J.; Payne, Rachael M.; Tandon, Damini; Chi, David; Evans, Adam; Pet, Mitchell A.

doi:10.1016/j.injury.2023.04.042

Cited by 2 publications

(7 citation statements)

References 8 publications

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“…In this study, 85% of SI GSWs and only 33% of NSI GSWs were to the hand. This is consistent with previous studies that have identified a greater incidence of SI GSWs to the hand [ 3 , 5 , 7 , 11 ]. Previous studies have examined specific injury locations within the hand and identified SI GSWs to be associated with the most distal structures (proximal phalanges) and NSI GSWs to be associated with more proximal structures (metacarpals) [ 3 , 7 ].…”

Section: Discussionsupporting

confidence: 93%

“…The NSI group also demonstrated a higher incidence of multiple wounds. This is consistent with previous studies and is most likely attributed to a violent context rather than an accidental discharge [ 3 , 5 ]. There was no difference in fracture rate between the groups with fractures occurring in 50–60% of the cases.…”

Section: Discussionsupporting

confidence: 93%

“…The demographic results of our study found older, white males to be most likely to have self-inflicted GSWs and younger, non-white males to have non-self-inflicted GSWs. This is consistent with previous studies evaluating the epidemiology of SI versus NSI GSWs [ 3 , 5 , 7 , 9 ]. Further, we found that SI GSWs were most likely to occur in manual workers, while NSI GSWs were most likely to occur in retired/unemployed individuals.…”

Section: Discussionsupporting

confidence: 93%

“…These results differ from our original hypothesis that the SI group would require more surgical intervention. Previous studies have stated that around 30–50% of SI GSWs require OR interventions, with the most OR interventions needed for more distal injuries [ 5 , 7 , 11 ], and up to 65% of self-inflicted GSW cases require surgical treatment and have a higher incidence of multiple OR trips [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have begun to identify the differences in high-velocity injuries associated with self-inflicted GSW injuries; however, there is still a need to further understand injury patterns [ 5 ]. Due to the proximity of neurovascular structures within the hand and distal upper extremity, hand and upper extremity surgeons need to have an understanding of the mechanism and patterns to help guide optimal treatment decisions.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Self-Inflicted versus Non-Self-Inflicted Gunshot Wounds and Associated Injuries Involving the Hand and Upper Extremity

Pan,

Giuffrida,

Trivedi

et al. 2024

Healthcare

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Orthopedic costs associated with gunshot wounds (GSWs) totaled approximately USD 510 million from 2005 to 2014. Previous studies have identified differences in injuries associated with self-inflicted (SI) GSWs; however, there remains a gap in understanding injury patterns. This study aims to expand upon the current literature and shed light on injury patterns and outcomes associated with SI vs. non-self-inflicted (NSI) GSWs. This is a retrospective cohort study of upper extremity GSWs from January 2012 to December 2022. Data were analyzed using the two-sample t-test, Pearson’s chi-squared test, and Fisher’s exact test. SI GSWs tended to be high-velocity GSWs and occurred more often in distal locations compared to NSI GSWs (p = 0.0014 and p < 0.0001, respectively). SI GSWs were associated with higher Gustilo–Anderson (GA) and Tscherne classifications (p < 0.0001 and p = 0.0048, respectively) and with a greater frequency of neurovascular damage (p = 0.0048). There was no difference in fracture rate or need for operative intervention between the groups. GA and Tscherne classifications were associated with the need for and type of surgery (p < 0.0001), with a higher classification being associated with more intricate operative intervention; however, GSW velocity was not associated with operative need (p = 0.42). Our findings demonstrate that velocity, wound grading systems, and other factors are associated with the manner in which GSWs to the upper extremity are inflicted and may thus have potential for use in the prediction of injury patterns and planning of trauma management and surgical intervention.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Evaluation of Self-Inflicted versus Non-Self-Inflicted Gunshot Wounds and Associated Injuries Involving the Hand and Upper Extremity

Pan,

Giuffrida,

Trivedi

et al. 2024

Healthcare

View full text Add to dashboard Cite

show abstract

Upper Extremity Ballistic Nerve Injury

Wolf,

Chen,

Strelzow

et al. 2024

JBJS Reviews

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» Gunshot injuries to the upper extremity (UE) have high likelihood for causing peripheral nerve injury secondary to the high density of vital structures. Roughly one-fourth of patients sustaining a gunshot wound (GSW) to the UE incur a nerve injury. Of these nerve injuries, just over half are neurapraxic. In cases of surgical exploration of UE nerve injuries, nearly one-third demonstrate a transected or discontinuous nerve.» Existing literature regarding surgical management of nerve injuries secondary to GSWs comes from both military and civilian injuries. Outcomes are inconsistently reported, and indications are heterogeneous; however, reasonable results can be obtained with nerve reconstruction.» Our proposed management algorithm hinges on 4 treatment questions: if there is a nerve deficit present on examination, if there is a concomitant injury in the extremity (i.e., fracture or vascular insult), whether the injured nerve would be in the operative field of the concomitant injury, and whether there was an identified nerve lesion encountered at the time of surgery by another surgeon?» Early exploration rather than continued expectant management may offer improved recovery from GSW nerve injuries in particular situations. When an UE nerve deficit is present, establishing follow-up after the initial GSW encounter and early referral to a peripheral nerve surgeon are pivotal.

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Mechanism matters: A 10-year experience of ballistic injuries of the upper extremity

Cited by 2 publications

References 8 publications

Evaluation of Self-Inflicted versus Non-Self-Inflicted Gunshot Wounds and Associated Injuries Involving the Hand and Upper Extremity

Evaluation of Self-Inflicted versus Non-Self-Inflicted Gunshot Wounds and Associated Injuries Involving the Hand and Upper Extremity

Upper Extremity Ballistic Nerve Injury

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