The epidemiology and orthopaedic burden of civilian gunshot injuries over a four-year period at a level one trauma unit in Cape Town, South Africa

Jakoet, Shafique; Burger, Marilize; Heukelum, M Van; Roux, Nicholas Le; Gerafa, Muaad; Merwe, S van der; Makabalo, O; Ferreira, Nando

doi:10.1007/s00264-020-04723-6

Cited by 13 publications

(13 citation statements)

References 17 publications

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“…This was likely due to the low average age of the cohort, which was younger than similar studies [ 26 , 29 ]. However, the average age was in keeping with the profile of patients presenting to a high-volume trauma unit [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

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Proximal femur anatomy-implant geometry discrepancies

Cornelissen

Ferreira

Burger

et al. 2022

SICOT-J

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Objectives: Due to ongoing concern about femur anatomy-implant mismatches, this cross-sectional study aimed to create a geometric femur profile and used it to identify and quantify possible mismatches between femur anatomy and cephalomedullary nail dimensions. The work further aimed to assess whether patient demographics affect anatomy-implant coherence. Methods: One hundred skeletally mature complete femur computer tomography (CT) scans were collected and exported to software enabling landmark placement and measures with multiplanar reconstruction techniques. Results: Clinically relevant anatomy-implant discrepancies included the femur neck and shaft axis offset 6.1 ± 1.7 mm (95% CI [5.7–6.4]), femur radius of curvature 1.2 ± 0.3 m (95% CI [1.1–1.2]), femur anteversion 18.8 ± 9.2 (95% CI [16.9–20.6]). The implants reviewed in this study did not compensate for the femur neck and shaft axis offset and had a larger radius of curvature than the studied population. Clinically significant demographic geometry differences were not identified. Conclusion: There were discrepancies between femur anatomy and cephalomedullary nail implant design; however, no clinically significant femur feature inconsistency was identified among the demographic subgroups. Due to the identified anatomy-implant discrepancies, including the femur neck and shaft axis offset, we suggest that these measurements be considered for future implant design and surgical technique.

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Section: Discussionmentioning

confidence: 99%

“…Proximal femur fracture incidence rises due to aging populations and increased trauma events [ 1 , 2 ]. Reconstruction of proximal femur anatomy and accurate implant placement remains paramount to negate fixation failure [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Proximal femur anatomy-implant geometry discrepancies

Cornelissen

Ferreira

Burger

et al. 2022

SICOT-J

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“…The first finding of this study was the demographic sample and the predominant involvement of young males (89% male with a mean age of 29.2±10.2 years), which is similar to previous published reports on orthopaedic injuries following civilian gunshots. 3,6,8 A recent study conducted in South Africa reported a higher rate of intentional and gang-related violence together with the use of alcohol and illegal drugs among young, gunshot-injured males. 5 While we did not test patients for alcohol or illegal drugs in the present study, our finding, together with the previous reports, again highlights this group of individuals to be a potential target for intervention in the future.…”

Section: Discussionmentioning

confidence: 99%

“…5 In agreement with this, a recent study from a tertiary hospital in South Africa reported a total of 1 449 gunshot-related orthopaedic fractures over a four-year period, resulting in a total cost of more than ZAR 50 million to the healthcare system. 6 Gunshot-induced tibia fractures are often associated with a myriad of complications presenting greater challenges to clinicians. Gunshots involve the transfer of blast energy to the bone and soft tissue resulting in cavitary tissue damage and a large zone of injury.…”

Section: Introductionmentioning

confidence: 99%

Treatment outcomes of civilian gunshot tibia fractures at a major trauma centre

et al. 2021

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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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“…We should also consider that people who experience musculoskeletal injury are sometimes involved in risky and even self-destructive behavior that might be associated with feelings of despair, worthlessness, and worry. Consider the impact of unhealthy substance use, 2,3 crime, 4 or risky driving. 5 Some people are involved in risky work such as construction or a risky sport or avocation.…”

Section: Introductionmentioning

confidence: 99%

Recovery After Musculoskeletal Injury: Mental and Social Health

Ring

2022

Journal of Orthopaedic Trauma

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Recovery from injury involves painful movement and activity, painful stretches and muscle strengthening, and adjustment to permanent impairment. Recovery is facilitated by embracing the concept that painful movement can be healthy, which is easier when one has more hope, less worry, and greater social supports and security. Evolution of one's identity to match the new physical status is a hallmark of a healthy outcome and is largely determined by mental and social health factors. When infection, loss of alignment or fixation, and nerve issues or compartment syndrome are unlikely, greater discomfort and incapability that usual for a given pathology or stage of recovery signal opportunities for improved mental and social health. Surgeons may be the clinicians most qualified to make this discernment. A surgeon who has gained a patient's trust can start to noticed despair, worry, and unhelpful thinking such as fear of painful movement. Reorienting people to greater hope and security and a healthier interpretation of the pains associated with the body's recovery can be initiated by the surgeon and facilitated by social workers, psychologist, and physical, occupational and hand therapists trained in treatments that combine mental and physical therapies.

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The epidemiology and orthopaedic burden of civilian gunshot injuries over a four-year period at a level one trauma unit in Cape Town, South Africa

Cited by 13 publications

References 17 publications

Proximal femur anatomy-implant geometry discrepancies

Proximal femur anatomy-implant geometry discrepancies

Treatment outcomes of civilian gunshot tibia fractures at a major trauma centre

Recovery After Musculoskeletal Injury: Mental and Social Health

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