Pediatric Gunshot Wounds of the Upper Extremity

Abstract

BACKGROUND: Gunshot wounds to the upper extremity in pediatric patients are an uncommon injury, but their impact on the patient can be severe. They can be accompanied by nerve damage, bone fracture, or tendon rupture. The most common cause of these pediatric gun injuries is unintentional firearm discharge. The most common type of firearm involved overall is a powdered weapon; however, non-powder weapons are a significant contributor to pediatric firearm injury. The purpose of this study is to describe the characteristics and treatment outcomes of pediatric GSW in a level one trauma center on the US-Mexican border. METHODS: Retrospective case series. RESULTS: Ten patients met our inclusion criteria for the study. The most frequent mechanism of injury was due to violence (60%), and the most frequent type of firearm involved was a powdered weapon (80%). Males were more affected than females (70%). Six patients experienced bone fracture, three patients experienced nerve damage, and one patient experienced tendon damage. No patients had lasting physical deficits as the result of their injury. CONCLUSION: Most of the pediatric GSW (60%) were due to violence. However, a significant percentage was due to accidental injury (40%). Addressing powder and non-powder weapon safety is warranted to reduce firearm injury in the pediatric population. Good outcomes can be expected in most pediatric GSW.

Toy Guns, Real Danger: An Update on Pediatric Injury Patterns Related to Nonpowder Weapons

“…In this study, we found that half the study population underwent a major surgical procedure, which supports the existing literature [18]. This is the first study on a national level to describe the specific procedures performed on children and young adults with nonpowder weapon injuries, with prior work having focused on specific injuries or body parts rather than all injuries and all procedures [2,3,19]. While the majority of procedures were relatively low acuity or complexity, a concerning number of children required significant surgical intervention.…”

Best Practices for Orthopaedic Treatment of Pediatric Gunshot Injuries

“…1 Of those injured, 19,583 (38%) had an injury to their extremity. 5,7,[9][10][11][12][13][15][16][17][18][19][20][21][22][23][24]26 The lower extremity was more often involved than the upper extremity (51%). 6,11,13,15,17,[19][20][21]23,24,26 Handguns were involved in 76% of the incidents, followed by shotguns (11%), non-powdered weapons (7%), and rifles (2%) (Figure 2).…”

“…6,11,13,15,17,[19][20][21]23,24,26 Handguns were involved in 76% of the incidents, followed by shotguns (11%), non-powdered weapons (7%), and rifles (2%) (Figure 2). [7][8][9][10][11][13][14][15]17,[20][21][22][23] Most of • Children with gun injuries involving the physis should be followed for growth arrests and those with retained bullet fragments close to bone or joints for lead toxicity. the victims were assaulted (63%) or a target for violence, whereas 33% were accidental, 3% were suicide attempts, and 1% were due to law enforcement.…”

“…13,14 Older children were more likely to be a victim of gun violence, with 88% greater than 14 yearsold. 5,6,9,11,12,14,15,[17][18][19]22 They were more likely to be assaulted, compared to younger children who were most often unintentionally shot. 8,11,14,23 One-third of pediatric fatalities from gun violence died in the field.…”

Fibular Allograft Osteoplasty and Silicone Arthroplasty following Gunshot Injury of the Metacarpal

“…1,2 This presents an etiology of significant morbidity in both adult and pediatric populations. 3 Optimal treatment consists of debridement, antibiotics, reconstruction, and rehabilitation. 2 Among patients requiring surgery, those presenting with simultaneous bone and joint defects provide a unique reconstructive challenge.…”