Orthopaedic firearm injuries in children and adolescents: An eight-year experience at a major urban trauma center |
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| Affiliation: | 1. Department of Surgery, Kern Medical Center, USA;2. Department of Radiology, Kern Medical Center, USA;1. Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States;2. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States;3. The Leonard Davis Institute, Wharton School of Business at the University of Pennsylvania, Philadelphia, PA, United States;4. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States;5. Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States;6. Department of Emergency Medicine, Jefferson University School of Philadelphia Medicine, PA, United States;1. Department of Trauma Research, Medical Center of Plano, 3901 West 15th Street, Plano, TX 75075, United States;2. Department of Trauma Research, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO 80113, United States;3. Department of Trauma Research, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO 80228, United States;4. Trauma Services Department, Medical Center of Plano, 3901 W. 15th St, Plano, TX 75075, United States;5. Trauma Services Department, St. Anthony Hospital, 11600 West 2nd Place, Lakewood, CO 80228, United States;7. Trauma Services Department, Swedish Medical Center, 499 E. Hampden Ave, Englewood, CO 80113, United States;6. Trauma Services Department, Intermountain Neurosurgery, 11700 W. 2nd Place, Lakewood, CO 80228, United States;8. Trauma Services Department, Rocky Vista University, 8401 S. Chambers Rd, Parker, CO 80134, United States;1. Department of Trauma, Division of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands;2. The Royal Netherlands Navy (R) and Department of Traumatology, Division of Surgery, Medical Center Haaglanden – Bronovo, The Hague, The Netherlands;3. Royal Netherlands Army and Department of Surgery-Trauma, Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands;4. United States Air Force and The Norman M. Rich Department of Surgery, The Uniformed Services University of the Health Science, Bethesda, United States;5. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands;1. Department of Surgery, University of Washington, Seattle, WA, USA;2. School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;3. Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana;4. Department of Community Medicine, Al Munstansiriya University, Baghdad, Iraq;5. Human Resources Development and Training Center, Iraq Ministry of Health, Baghdad, Iraq;6. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA;7. Department of Global Health, University of Washington, Seattle, WA, USA;8. Institute for Health Metrics and Evaluation, Seattle, WA, USA;9. Department of Health Services, University of Washington, Seattle, WA, USA;10. Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;11. Surgeons OverSeas (SOS), New York, NY, USA;12. Department of Surgery, Columbia University, New York, NY, USA;13. Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa;1. Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, United States;2. Bureau of Sciences Services, Wisconsin Department of Natural Resources, United States;3. National Farm Medicine Center, Marshfield Clinic Research Foundation, United States |
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| Abstract: | IntroductionThe purpose of this study is to describe the epidemiology of orthopaedic injuries incurred secondary to firearms among children and adolescents at a major metropolitan trauma center and to identify risk factors for complications and long-term morbidity.MethodsA retrospective review was performed of consecutive patients 17 years of age and younger who sustained a firearm injury and required orthopaedic treatment at a major trauma center from 2006 to 2013. Patient demographics, injury mechanism, fracture classification, neurovascular injury, antibiotic administration, and length of hospitalization were recorded. Radiographic studies were used to determine fracture pattern, methods of stabilization, and time to union. Primary clinical outcomes include fracture nonunion, infection, and physeal arrest.Results46 patients with a mean age of 12.7 years were treated for firearm related orthopaedic injuries. 72% of the patients were ages 13–17, while 28% were 12 years of age and younger. There were 28 violent injuries (21 assaults, 7 innocent bystanders) and 16 non-violent injuries (15 unintentional discharges and 1 self-inflicted). There was a bimodal distribution of violent versus nonviolent mechanisms, with the majority of children 12 years of age and under sustaining non-violent injuries and adolescents more commonly injured with a violent mechanism.There were 44 fractures and 6 traumatic arthrotomies, with eight associated neurovascular injuries. Twenty-five patients had an orthopaedic procedure, with a total of 43 surgeries. Mean hospital length of stay was 6.8 days. There were five deep infections. Four patients developed non-unions and all of these patients had deep infections. The timing and duration of antibiotic therapy was not significantly different between those who did and did not develop infection. Of the non-operatively treated fractures, there were no infections or non-unions at long-term follow-up.ConclusionsMorbidity and mortality related to firearms is a growing public health problem in the United States. Results of this study suggest that gunshot related fractures had higher than anticipated morbidity, including permanent neurologic deficits, infection (11%) and fracture non-union (9%). More than half of patients underwent surgery and experienced long hospital stays secondary to the complexity of the injury. This epidemiological data on firearm injuries in children and adolescents is an impetus for prospective study, with the goal to increase awareness and develop treatment strategies for firearm-related fractures. |
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| Keywords: | Paediatrics Orthopaedics Injury prevention Gun violence Fracture Infection |
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