Point Blank: A Retrospective Review of Self-inflicted Gunshot Wounds to the Hand

Abstract

Background A paucity of literature exists specifically examining self-inflicted (SI) gunshot wounds (GSWs) to the hand and wrist, which impart greater energy and have a higher risk of adverse events than non–self-inflicted (NSI) GSWs. Methods We retrospectively reviewed records of patients who presented to our plastic surgery service after sustaining acute GSWs involving the hand and wrist between 2016 and 2018. Results We identified 60 patients who sustained GSWs involving the hand and wrist; 17 (28%) were SI, and 43 (72%) were NSI. Within the SI group, 100% of patients were Caucasian, with an average age of 54 years. Within the NSI cohort, 77% of patients were Black, 19% were Caucasian, and 4% identified as other. While not statistically significant, we noted a substantial increase in patients requiring operative intervention in the SI cohort (65% SI vs 37% NSI, P = .08). There was a statistically significant increase in patients requiring more than 1 operation in SI patients (24% SI vs 5% NSI, P = .04). Patients who sustained SI injuries were also more likely to present with acute carpal tunnel syndrome requiring urgent surgical release and to develop wound infections (12% vs 0%, P = .08). Conclusions Self-inflicted GSWs involving the hand and wrist are associated with greater morbidity than their low-energy NSI counterparts. Individuals presenting with SI GSWs are more likely to be older, to require multiple operations, to develop infections, and to present with acute carpal tunnel syndrome requiring urgent surgical decompression.

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

“…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 ]. The current study examined injury locations across the entire upper extremity.…”

“…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.…”

“…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.…”

“…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 ].…”

“…Approximately 17% of all nonfatal gunshots and 70% of unintentional gunshot wounds involve the upper extremity [ 3 ]. Gunshot fractures often do not follow injury patterns observed in blunt injury scenarios, leading to complex and challenging stabilization.…”