Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, 30 E. Apple St. Suite #2200, Dayton, OH 45409-2932, United States of America.
Injury. 2022 Nov;53(11):3663-3672. doi: 10.1016/j.injury.2022.09.011. Epub 2022 Sep 14.
Ballistic (i.e., gunshot-induced) fractures present unique treatment challenges and can be associated with high rates of complications and considerable morbidity. Large-scale epidemiologic data on these types of fractures are scarce. There is concern that gun-related violence may be on the rise, potentially increasing the burden of ballistic orthopaedic trauma, but there are few contemporary studies on the topic. The aim of this study, therefore, was to investigate the incidence and demographics of patients with ballistic fractures in the United States (US) over the last 20 years.
This descriptive epidemiology study retrospectively analyzed the Firearm Injury Surveillance Study to identify cases of ballistic fractures in the US from 2000 to 2019. Overall and annual numbers of fractures and fracture incidence rates (IRs), patient demographics, incident characteristics, and temporal trends were analyzed. Patients of all ages were included. Ballistic fractures were grouped by anatomic location for comparisons (non-spine axial, spine, upper extremity, lower extremity).
An estimated N = 240,555 patients (n = 8,322 unweighted cases) sustained ballistic fractures over the 20-year study period for an overall IR of 39.2 per 1,000,000 person-years at-risk (PYR). Overall, lower extremity fractures accounted for the largest percentage of cases (45.9%; IR=18.8 PYR), followed by upper extremity fractures (32.8%; IR=13.4 PYR), non-spine axial fractures (16.1%; IR=6.6 PYR), and spine fractures (5.2%; IR=2.1 PYR). Diaphyseal femur fractures were the most common ballistic fractures overall. Nearly three-fourths (71.2%) of all cases occurred in males in the second through fourth decades. The most common injury intent was assault (71.8%) and a majority of patients (71.2%) required hospital admission. Accounting for population growth yielded a significantly increasing incidence of all ballistic fractures over the study period from 15.7 PYR in 2000 to 96.8 PYR in 2019 (average annual percent change=10.3, p < 0.00001).
These data suggest that the nationwide burden of ballistic fractures in the US has increased significantly in the last two decades. Ballistic fractures are associated with significant morbidity and societal cost, and increasing injury rates highlight the need for future research aimed at better understanding the ideal treatment of these types of fractures and their outcomes.
弹道（即枪击引起）骨折具有独特的治疗挑战，可能导致高并发症发生率和相当大的发病率。关于这些类型骨折的大规模流行病学数据很少。有人担心与枪支有关的暴力可能正在上升，这可能会增加弹道骨科创伤的负担，但关于这个主题的当代研究很少。因此，本研究的目的是调查过去 20 年来美国（美国）弹道骨折患者的发病率和人口统计学特征。
本描述性流行病学研究回顾性分析了枪支伤害监测研究，以确定 2000 年至 2019 年美国弹道骨折病例。分析了骨折的总数和年度数量以及骨折发生率（IR）、患者人口统计学特征、事件特征和时间趋势。所有年龄段的患者均包括在内。弹道骨折按解剖部位进行分组比较（非脊柱轴向、脊柱、上肢、下肢）。
在 20 年的研究期间，估计有 240555 名患者（未加权病例数为 8322 例）发生了弹道骨折，总体发病率为每 1000000 人年风险（PYR）39.2 例。总体而言，下肢骨折占病例的最大比例（45.9%；IR=18.8 PYR），其次是上肢骨折（32.8%；IR=13.4 PYR）、非脊柱轴向骨折（16.1%；IR=6.6 PYR）和脊柱骨折（5.2%；IR=2.1 PYR）。股骨干骨折是总体上最常见的弹道骨折。近四分之三（71.2%）的病例发生在 20 岁至 40 岁的男性中。最常见的受伤意图是攻击（71.8%），大多数患者（71.2%）需要住院治疗。考虑到人口增长，研究期间所有弹道骨折的发病率显著增加，从 2000 年的 15.7 PYR 增加到 2019 年的 96.8 PYR（平均年变化率为 10.3%，p<0.00001）。
这些数据表明，过去 20 年来，美国弹道骨折的全国负担显著增加。弹道骨折与显著的发病率和社会成本相关，受伤率的增加突出表明需要进一步研究，以更好地了解这些类型骨折的理想治疗方法及其结果。
