Pan Tommy, Giuffrida Brianne M, Trivedi Amol H, Contestabile Dom, Vyas Praveer S, Cheng Boyle C, Altman Daniel T, Regal Steven M
Allegheny Health Network Orthopaedic Institute, Pittsburgh, PA 15212, USA.
Drexel University College of Medicine, Drexel University, University City Campus, Philadelphia, PA 19104, USA.
Healthcare (Basel). 2024 Feb 29;12(5):564. doi: 10.3390/healthcare12050564.
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 -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 ( = 0.0014 and < 0.0001, respectively). SI GSWs were associated with higher Gustilo-Anderson (GA) and Tscherne classifications ( < 0.0001 and = 0.0048, respectively) and with a greater frequency of neurovascular damage ( = 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 ( < 0.0001), with a higher classification being associated with more intricate operative intervention; however, GSW velocity was not associated with operative need ( = 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.
2005年至2014年期间，与枪伤（GSW）相关的骨科费用总计约5.1亿美元。先前的研究已经确定了与自伤性（SI）枪伤相关的损伤差异；然而，在理解损伤模式方面仍存在差距。本研究旨在扩展现有文献，阐明与自伤性枪伤与非自伤性（NSI）枪伤相关的损伤模式和结果。这是一项对2012年1月至2022年12月上肢枪伤的回顾性队列研究。使用双样本t检验、Pearson卡方检验和Fisher精确检验对数据进行分析。与非自伤性枪伤相比，自伤性枪伤往往是高速枪伤，且更常发生在远端部位（分别为P = 0.0014和P < 0.0001）。自伤性枪伤与更高的 Gustilo-Anderson（GA）和Tscherne分级相关（分别为P < 0.0001和P = 0.0048），并且神经血管损伤的频率更高（P = 0.0048）。两组之间的骨折率或手术干预需求没有差异。GA和Tscherne分级与手术需求和手术类型相关（P < 0.0001），分级越高，手术干预越复杂；然而，枪伤速度与手术需求无关（P = 0.42）。我们的研究结果表明，速度、伤口分级系统和其他因素与上肢枪伤的致伤方式有关，因此可能有潜力用于预测损伤模式以及规划创伤管理和手术干预。
