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. 2024 Apr 17;12(4):e5753.
doi: 10.1097/GOX.0000000000005753. eCollection 2024 Apr.

The Epidemiology, Management, and Outcomes of Civilian Gunshot Wounds to the Upper Extremity at an Urban Trauma Center

Tessa E Muss  1 , Sophia Hu  1 , Andrew R Bauder  1 , Ines C Lin  1
Affiliations

The Epidemiology, Management, and Outcomes of Civilian Gunshot Wounds to the Upper Extremity at an Urban Trauma Center

Tessa E Muss et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: Gunshot wounds (GSWs) create significant morbidity in the United States. Upper extremity (UE) GSWs are at high risk of combined injuries involving multiple organ systems and may require variable treatment strategies. This study details the epidemiology, management, and outcomes of civilian UE GSWs at an urban level 1 trauma center.

Methods: Using the University of Pennsylvania Trauma Registry, all adult patients with UE GSWs from 2015 to 2020 who were at least 6-months postinjury were studied for demographics, injury pattern, operative details, and postoperative outcomes. Fisher exact and Wilcoxon rank sum tests were used to determine differences in treatment modalities and outcomes.

Results: In 360 patients, the most common victim was young (x̄ = 29.5 y old), African American (89.4%), male (94.2%), and had multiple GSWs (70.3%). Soft tissue-only trauma (47.8%) and fractures (44.7%) predominated. Presence of fracture was independently predictive of neurologic, vascular, and tendinous injuries (P < 0.001). Most soft tissue-only injuries were managed nonoperatively (162/173), whereas fractures frequently required operative intervention (115 of 161, P < 0.001). Despite a prevalence of comminuted (84.6%) and open (43.6%) fractures, hardware complications (7.5%) and wound infection (1.1%) occurred infrequently.

Conclusions: Civilian GSWs to the UE with only soft tissue involvement can often be managed conservatively with antibiotic administration, bedside washout, and local wound care. Even with combined injuries and open fractures, single-stage operative debridement and fracture care with primary or secondary closure often prevail. As civilian ballistic trauma becomes more frequent in the United States, these data help inform patient expectations and guide management.

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Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Fractures by anatomic location.
Fig. 2.
Fig. 2.
Time to OR for all fractures, Gustilo I, Gustilo II, and Gustilo III injuries.
Fig. 3.
Fig. 3.
Fixation modality for all fractures. CRPP; IMN, intramedullary nailing; OR; ORPP.
Fig. 4.
Fig. 4.
Operative management of nerve injuries. AIN, anterior interosseous nerve; MABC, medial antebrachial cutaneous; PIN, posterior interosseous nerve.
Fig. 5.
Fig. 5.
Operative management of vascular injuries.
See this image and copyright information in PMC

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