Gunshot Wounds Research Articles

Lumbar artery pseudoaneurysm in traumatic spinal cord injury from a gunshot wound: A case report

Lumbar artery pseudoaneurysms are a rare complication of penetrating trauma that can result in devastating retroperitoneal hemorrhage or embolic complications if left untreated. Prompt recognition in the trauma setting can lead to timely definitive diagnosis via spinal angiography and treatment via endovascular embolization. We present a case of lumbar artery pseudoaneurysm secondary to a gunshot wound to the spine treated via coil embolization.

Management of 52 small bowel perforations following gunshot injury: A case report

Abstract Small bowel injury is one of the most common abdominal injuries following penetrating injuries and is usually secondary to gunshot, stab, or impalement injuries to the abdomen. We report a case of shotgun injury to the abdomen in a hemodynamically stable man. He had an emergency exploratory laparotomy, during which 52 small bowel perforations and 1 transverse colon perforation were found. He was managed by damage control surgery involving a temporary nonclosure of the anterior abdominal wall with resuscitation and a second look laparotomy after 48 h.

Functional and Radiographic Outcomes of Open Proximal Femoral Fractures Caused by Gunshot Wounds in Yemen: A Prospective Cohort Study.

Open proximal femoral fractures caused by gunshot wounds are rare but devastating injuries that pose considerable challenges for prognosis and management. The aim of this study was to evaluate the functional and radiographic outcomes of patients with open proximal femoral fractures caused by gunshot wounds treated at 3 Level-I trauma centers in Yemen and to identify the factors that influence them. We prospectively enrolled 174 patients with open proximal femoral fractures caused by gunshot wounds. The fractures were classified according to the Gustilo-Anderson and OTA/AO systems. The primary outcome measures were fracture union, infection, and functional outcomes. The secondary outcome measures were the Harris hip score (HHS) and the Short Form-36 (SF-36) health survey score. We performed multivariable logistic regression modeling to identify the predictors of complications and poor functional outcomes. The overall rate of fracture union was 87%. The complication rates were 18% for infection, 13% for nonunion, 23% for reoperation, 12% for delayed union, 4% for osteonecrosis, 6% for heterotopic ossification, and 2% for amputation. The mean HHS at the final follow-up was 78.4, and the mean SF-36 score was 67.3. Open proximal femoral fractures caused by gunshot wounds are associated with high rates of complications and poor functional outcomes in Yemen. Early debridement, appropriate fixation, infection control, and adequate soft-tissue coverage are essential for achieving satisfactory results. The type of wound, the type of fracture, and the type of definitive fixation are significant predictors of the outcomes. Future studies should compare different fixation methods and evaluate the long-term outcomes and complications of these injuries. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Gunshot wounds to animals

Gunshot injuries are quite common in various animal species. In 40.0% of cases, this type of damage was detected on the corpses of roe deer, in 26.67% of cases, damage was noted on the corpses of Manchurian elk, 13.33% of cases were registered in horses and cattle. In 6.67% of cases, injuries were found on the dog’s corpse. In 40.0% of the cases, the injuries corresponded to blind gunshot wounds and were represented by an entrance gunshot wound and a wound channel. There was no exit wound. In 33.33% of the injuries corresponded to perforating gunshot and were represented by an entrance and exit wound opening and wound canal. 20% of the identified injuries are represented by tangential gunshot wounds, characterized by the presence of an open wound canal. In 6.67% of cases, injuries were attributed to bruised gunshot.

Penetrating abdominal stab and gunshot injuries: 10-year experience of a secondary public hospital located in a suburban area with solo surgeons.

Trauma care systems are life-saving significant implementations of a country's healthcare systems. Trauma care requires well-established trauma settings and organizations with experienced trauma teams including experienced emergency medicine, surgery and anesthesiology staff. This study aimed to investigate the outcomes of penetrating abdominal injuries treated by solo surgeons in a suburban area. Medical records of the patients who were admitted to the emergency department with penetrating abdominal injuries between January 2012 and December 2021 were retrospectively analyzed. Patients were evaluated based on their injury sites and treatment approaches. In total, 110 patients with anterior abdominal penetrating injuries were enrolled in the study; 83 (75.4%) were stabbed and 27 (24.6%) had gunshot wounds. According to the injury site, there were 90 (81.8%) anterior; 11 (11%) right thoracoabdominal and 9 (7.2%) left thoracoabdominal injuries. Fifty-one (61.4%) stab wounds were treated with immediate laparotomy and 21 (41.1%) of these operations resulted in negative or nontherapeutic laparotomy. Also, 32 (38.6%) stab wounds were managed nonoperatively; three (9.3%) failed conservative management and received delayed laparotomy. All gunshot wounds were treated with immediate laparotomy and 14.8% resulted in either negative or nontherapeutic laparotomy. On-call surgeons were found to be more prone to perform immediate laparotomy on weekends when they were on call for 48 or 72 hours. Being a solo surgeon may increase negative laparotomy rates of penetrating abdominal injuries. This high percentage (41.1%) of negative laparotomy rates can be reduced by establishing well-organized trauma teams.

“The Smoking Gun” Evidence in the Tragic Death of Vincent Van Gogh

It has been widely accepted in the past that Vincent Van Gogh died of a self-inflicted gunshot wound in a field outside of Auvers-sur-Oise, France. However, much of the new evidence points to another theory: Van Gogh didn’t kill himself but was murdered. The updated forensic research into this cold case is significant for the art community and art historians interested in the truth. Interviews, letters, and records were compiled and reviewed in detail, including evidence regarding the potential weapon and possible persons of interest. Van Gogh’s wound was described as pea sized, surrounded by discoloration with no exit wound or powder burn. The records of these details have been reviewed by a forensic pathologist, who concluded the unlikelihood of self-infliction. No potentially related gun, bullet, or other weapon were found immediately following his death. However, 60 years later a rusted and significantly damaged non-functioning Lefaucheux pinfire revolver was found in a wheat field, coincidentally and somewhat suspiciously, as the movie, LUST FOR LIFE, was being filmed on site. Whether this weapon, recently auctioned for approximately $183,000 USD, was related to his death is debated. Further investigation by a qualified gunsmith or forensic firearms examiner needs to be undertaken to determine if this gun was actually functional when it was “dropped” in the field or placed there to create additional buzz for BIG budget Hollywood production. Vincent van Gogh was allegedly shot in the abdomen on July 27, 1890, allegedly as critically there is no definitive evidence to support a gunshot wound. There is no smoking gun in evidence, no bullet, no suicide note, no exit wound, no black powder, no autopsy, no known crime scene, no witnesses, and no solid evidence of any kind to support a gun shot. All that is known for certain is that he sustained a penetrating wound to his abdomen. All one has to go on to make any kind of forensic analysis, or even confirm the possibility of a gunshot wound, is a description of the wound 26 years later.

Treatment of Brachial Plexus Injuries following Gunshot Injuries: A Systematic Review.

Brachial plexus injuries (BPI) from gunshot injuries are uncommon but usually severe and can cause chronic pain, loss of function, and permanent nerve damage. Multiple surgical techniques including neurolysis, end-to-end suture repair, and graft repair have been described for the treatment of these injuries. However, surgical indication, timing, and technique for these injuries remain controversial. This systematic review aims to investigate the treatment modalities for patients with BPI due to gunshot-related injuries. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology was employed for this review. PubMed, Cochrane Reviews, Embase, and CINAHL databases were included. The following keywords constituted our search criteria: gun-shot-wounds, brachial plexus, traum∗, and management. A total of 90 studies were imported for screening, from which 9 papers met our final inclusion/exclusion criteria. The most common studies utilized in this review were retrospective chart reviews followed by case series. In total, there were 628 patients that suffered from gunshot wounds to the brachial plexus. Most patients underwent some form of delayed nerve repair consisting of neurolysis, end-to-end epineural repair, or graft repair with a sural or antebrachial cutaneous nerve graft. Several patients suffered from complications, with neuroma being the most common long-term complication that required reoperation. The optimal timing for surgeries involving BPIs should be determined after examining the level of nerve damage, associated injuries, operative risks, and electrophysiological workup for indications of spontaneous regeneration. Early surgical interventions were indicated for patients presenting with associated vascular or thoracic injuries, compressive masses, and nerve transection by sharp instruments in most selected papers.

Clinical Characteristics, Treatment and Outcome of Gunshot Injuries in South West Region of Cameroon

Gunshot injuries have been on the rise in the south west region of Cameroon for the past 6 years due to the current socio-political crisis. With the increasing violence in the South West Region of Cameroon due to the socio-political crisis, proper management of Gunshot injuries at the local referral health facilities is very crucial. The outcome of management varies depending on factors such as firearm used, injury site, clinical presentation, and the time between injury and medical intervention. There is limited data on the management and outcome gunshot injuries in Cameroon, especially in the South West region .The aim was to provide data on the characteristics, management and outcome of gunshot injuries. We had as objective to describe the characteristics, treatment and outcome of gunshot injuries in South West, Cameroon

Pattern and Impact of gunshot injuries in Najran region, Saudi Arabia

Background and Aims: Gunshot injuries are common in war zones. This study retrospectively looks at the pattern of gunshot injuries presented to a tertiary care hospital in war zone. Methods: A retrospective analysis of data was carried out for 239 patients treated at King Khalid Hospital, Najran Saudi Arabia, for gunshot injuries from April 2016 to December 2017. The demographic data, anatomical site of gunshot injury, type of injury, and clinical outcome were analyzed. Results: The most affected age group was 16–35 years, while the most common site of injury was the lower extremities. War injuries accounted for 71% and civilian assaults for 29%. Wounds with inlet and outlet accounted for 55%, while injuries with only inlet wounds were 45%. The mortality rate was 7.9%, out of which the patients with head injuries had the highest mortality. There was a statistically significant positive relationship between head injury site and mortality (p < 0 .001), association between head injury site and penetration status (p = 0.006, as well as head injury site and nationality (p = 0.001). Conclusions: Findings reveal pattern of gunshot injuries in war zone consistent with the reported literature. Complete treatment and rehabilitation of patients with such injuries in active war zone can strain the tertiary care facilities

Are trauma victims with obesity lucky in penetrating trauma injuries?

We aimed to reveal the protective effect of body mass index (BMI) and subcutaneous adipose tissue thickness (SATT), together with scores covering the abdomen, in patients with penetrating abdominal trauma. The data of 234 abdominal penetrating trauma patients over the age of 16 who applied to the emergency general sur-gery unit of Istanbul Medipol Hospital between 2017 and 2021 were analyzed retrospectively. Sex, age, types of penetrating injuries, BMI, need for blood transfusion and intensive care unit (ICU), mortality, Injury Severity Score (ISS), Penetrating Abdominal Trauma Index (PATI), and Flint Colon Injury Score (FCIS) were recorded. The patients were divided into two groups: Gunshot Wound (GW) and Stab Wound (SW).While there was no significant difference in all parameters examined in all patients and GW patients in terms of BMI, a statistically significant difference was found in terms of blood transfusion need in SW patients (p=0.035). As a result of the Receiver Operating Characteristic curve analysis for the SATT variable, the cutoff value between mortality (p=0.866) and SATT (mm) values in all patients was 11 mm for all patients and 12 mm for GW patients. A significant difference was found in all patients and separately in GW and SW groups in terms of ICU and blood transfusion need, length of stay, ISS, PATI, and FCIS scores in non-operated patients (p<0.05). When all patients were examined, a statistically significant difference was found in terms of mortality (p=0.002). It is the first study to evaluate penetrating abdominal injuries with both BMI and SATT comprehensively and with all abdominal scores. A cutoff value to be determined for SATT with larger and multicenter studies can take its place as a parameter in the penetrating trauma algorithm.

Scoring system for unstable spinal gunshot wounds: the study protocol

To present a research protocol for development of new scoring system for unstable spinal gunshot wounds based on inter-expert agreement assessment. To create a new tactical classification, we will distinguish and analyze clinical and CT data of patients with thoracolumbar spinal gunshot wounds. The Delphi method will be used to collaborate between several surgeons. A three-stage study will result a questionnaire (for 30 clinical cases). We will develop tactical scoring system and analyze statistical data (kappa). Various classifications have been developed for closed spinal injuries. These systems describe the nature of injury and allow one to develop tactical decisions for further actions. Another mechanism of injuries following gunshot wounds does not allow the classification of closed injuries to be adequately applied in some cases. Indeed, spinal structures follow either direct passage of a wounding projectile through the spine or transferring the energy of this projectile in contrast to classical compression, distraction and rotational-translation mechanisms typical for closed trauma.

Evaluation of patients diagnosed with brain death in the intensive care unit: 10 years of tertiary center experience in Istanbul.

Early and accurate diagnosis of brain death in intensive care units (ICU) is essential for organ transplantation. This study aimed to evaluate the cases diagnosed with brain death in the ICU of a tertiary center in Istanbul. The cases diagnosed as brain death in the ICU during the ten years between January 2013 and September 2022 were evaluated retrospectively. The demographic characteristics of the patients, the diagnosis of hospitalization in the ICU, the time from arrival to the ICU until the diagnosis of brain death, the somatic survival time after the diagnosis of brain death, the acceptance rate of organ donation by the families and the organs removed were evaluated. A total of 44 patients were diagnosed with brain death. The mean age of the cases was 39.7±17.4 years, and 63% were male. The most common hospitalization diagnosis was intracranial hemorrhage (81.8%). Traffic accidents, hypertensive and aneurysm-related hemorrhages, gunshot wounds, and falls from height were the most common causes of intracranial hemorrhage. Patients were admitted to the ICU most frequently from the emergency department (54%). The mean time to brain death was 7.9±6.2 days, and the somatic survival time was 1.9±1.9 days in patients who did not receive organ transplantation. While the apnea test was positive in 91% of the cases, the apnea test could not be completed in 9% of the cases. While relatives of 7% (n=3) of the cases accepted organ donation, a patient was not allowed to be an organ donor for medical reasons. Organ transplantation was performed in two patients (5%). As in the whole world, getting treatment as soon as possible for the patients waiting on the organ transplant list in Turkiye by increasing the number of organs to be obtained from cadavers. In cases with suspected brain death in the ICU, diagnosing brain death as soon as possible and conducting family interviews with trained organ transplant coordinators will increase the number of cadaver donors. However, we think policies should be developed to ensure that society is informed and encouraged about brain death and organ donation.

Reconstruction of external nose to patients with mine-explosive injuries and gunshot wounds

Reconstruction of external nose to patients with mine-explosive injuries and gunshot wounds

Experiences with Penetrating Trauma in the Pediatric Intensive Care Unit

Aim:Penetrating traumas in children, caused by firearms or sharp instruments, are relatively rare, accounting for 10-20% of pediatric traumas. These traumas are serious and can lead to significant consequences, hence the need for prompt and multidisciplinary management. Materials and Methods:The study is a retrospective analysis of pediatric patients treated for PT in the intensive care unit. Patients were divided into two groups based on the cause of injury: sharp instrument wounds and firearm wounds. Data collected included age, gender, diagnosis at ICU admission, type of trauma, cause of trauma (assault, suicide), vital signs, nature of trauma (thoracic, abdominal, cranial, extremity), associated organ failures, surgical needs, performed surgeries or procedures, need for respiratory and cardiovascular support, transfusion requirements, lab parameters (blood gases and organ functions), ICU stay duration, and outcomes. Results:Between April 2022 and November 2023, a total of 425 pediatric cases were treated for trauma in the ICU, with a 6% frequency of PT. The majority of PT cases were in the adolescent age group and were male (76%). The cause of PT was violence in 88% (22/25) cases and attempted suicide in 12% (3/25) cases. 72% were caused by sharp objects and 28% were caused by gunshot wounds. The location of trauma was thoracic in 48% (12/25), abdominal in 44% (11/25), thoraco-abdominal in 4% (1/25), and lower extremity in 4% (1/25). There was no cranial penetrating trauma. In most cases (80%), thoracic and/or abdominal surgery, including tube thoracostomy, was required to treat hemopneumothorax. Blood transfusion was performed in 52% of the cases (13/25). Two cases required non-invasive mechanical ventilation, and one case required mechanical ventilation. The cases were hospitalized in the PICU for a mean period of 3,7 days. All cases were discharged. There were no deaths. Conclusion: Penetrating traumas are rare in children but can lead to serious consequences. Therefore, a rapid and multidisciplinary approach is vital in the management of PT cases in children.

Factors Associated with Development of Thigh Compartment Syndrome Following Subtrochanteric and Diaphyseal Femoral Fractures.

Acute compartment syndrome of the thigh (CST) is an ongoing challenge for orthopaedic surgeons as the diagnosis is often difficult to establish. Currently, there is a shortage of studies investigating risk factors for the development of thigh compartment syndrome following subtrochanteric and diaphyseal femoral fractures. This study aimed to identify risk factors associated with the development of CST following femoral fractures. Retrospective review performed in a level one trauma center from January 2011 to December 2020 for all patients with non-pathological acute subtrochanteric or diaphyseal femoral fractures. Variables collected included demographics, injury severity score (ISS) scores, mechanism of injury, classification of femoral fracture, open versus closed injuries, development of compartment syndrome, time to compartment syndrome diagnosis, number of subsequent surgeries, and primary wound closure versus split-thickness skin graft. The statistical analysis of this study included descriptive analysis, simple logistic regression, paired T-test, and Wilcoxon Signed Rank. Thirty-one (7.7%) patients developed thigh compartment syndrome following 403 subtrochanteric or diaphyseal femoral fractures. The mean (SD) age for those who developed CST was 27.35 (8.42). For every unit increase in age, the probability of developing CST decreased. Furthermore, male gender had 18.52 times greater probability of developing CST (P <0.001). AO/OTA 32-C3 and subtrochanteric femoral fracture patterns demonstrated 15.42 (P = 0.011) and 3.15 (P <0.001) greater probability of developing CST, respectively. Patients who presented to the hospital following a motor vehicle accident (MVA) or gunshot wound (GSW) had 5.90 (P= 0.006) and 14.87 (P < 0.001) greater probability of developing CST, respectively. Patients who were male, younger in age, and had a 32-C3 and subtrochanteric femoral fractures were at increased probability of developing CST. High energy trauma also increased the risk of developing CST. A high index of suspicion should be expressed in patients with these risk factors.

Medical care for a child with gunshot wound

Medical care for a child with gunshot wound

FEATURES OF THE APPLICATION OF A MAGNET FOR THE SURGICAL TREATMENT OF THE FIRE FRAGMENT WOUNDS OF THE THIGH AND BUTTOCKS. CLINICAL CASE

Introduction. Before the start of hostilities in Ukraine, the use of surgical magnetic instruments for the removal of ferromagnetic foreign bodies in everyday surgical practice was quite limited. The use of magnetic instruments provides, first of all, the possibility of control and safety of inflicting additional injuries during surgical operations. Materials and methods. The actual clinical observation and the complexity of the case of using a surgical magnet during the removal of a metal fragment due to a gunshot wound to the hip and buttock are demonstrated. Results. The primary surgical treatment of an open gunshot wound of the thigh and buttock with the presence of a foreign body on the radiograph of the pelvis in the direct and lateral projection near the lesser trochanter of the femur 5 hours after the injury with the use of surgical magnetic and classical surgical instruments (Billroth clamp) was performed on a 50-year-old patient. The small size of the wound entrance limited the ability to maneuver the instrument in the wound. And the deep immersion of the fragment in the soft tissues of the buttock made visualization and its palpation impossible. A significant risk of damage to large vessels and nerves during maneuvering is determined by the exact location of the fragment, the density of the metal, and the difficulty of its capture and fixation with a surgical instrument, due to the fragment sliding and catching on the femur. Conclusions. In complex cases, classic surgical instruments can be used along with magnetic instruments. Preoperative diagnosis of a foreign body should include X-ray examination if it is impossible to visualize and palpate the fragments. The use of surgical magnetic instruments expands the possibility of performing primary surgical treatment of wounds, reduces the traumatic nature of the operation and the terms of inpatient treatment and rehabilitation.

Surgical Care of a Young Man with a Gunshot Wound of the Abdomen

An 18-year-old male sustained an isolated gunshot wound to the abdomen with an entrance wound in the right lower quadrant. He was transported to a level 1 trauma center from an outlying hospital. He received tranexamic acid (1 gram) during transport. At the time of admission, he was alert and able to follow commands. The initial vital signs revealed Blood pressure - 136/110 Pulse-90 Respirations -21 and a temperature-97.9 degree. An initial FAST was positive. The CXR was clear. An arterial blood gas was performed with a base deficit of 0. The hemoglobin was 11.3 with a platelet count of 138,000. The patient was taken to the operating room for exploration with a unit of packed cells infusing.

Intraoperative magnet in removal of intracerebral metallic foreign bodies

Advisability of magnets in neurotrauma is due to pattern of patients admitted to neurosurgical departments of military hospitals with wounds accompanied by intracranial fixation of foreign metallic ferromagnetic bodies. To study dimensions, mass and magnetic properties of fragments extracted from gunshot wounds inflicted by modern weapons; to assess the feasibility of devices and instruments for removing foreign bodies. We analyzed foreign bodies extracted after gunshot wounds. Shape, dimension, weight and magnetic properties were studied. We estimated 532 foreign bodies (497 surgeries) extracted at the Kirov Military Medical Academy and 83 foreign bodies (79 surgeries) extracted at the Burdenko Military Clinical Hospital. Distribution by anatomical regions was established for both groups. We intraoperatively used cylindrical neodymium magnets 3×20 and 5×20 mm to extract magnetic foreign bodies. These magnets were brought to the target using standard surgical tweezers or original devices. The median mass of removed fragments was 0.385 (Q1-Q3=0.12-1.435; min-max≤0.01-30.5) g at the Kirov Military Medical Academy and 0.4 (Q1-Q3≤0.001-1.6; min-max≤0.01-11.4) g at the Burdenko Military Clinical Hospital. Magnetic foreign bodies were found in 501 (94.2%) and 74 (94.8%) cases, respectively. In 8.8% of cases, foreign bodies were not removed due to difficult-to-reach location accompanied by higher risk of adverse outcomes after extraction. Extracted foreign bodies after combat injuries have magnetic properties in 94% of cases. Intraoperative magnet allows for safe extraction of fragments in 91% of cases. Devices with adjustable magnetic field strength seem perspective. Further analysis of indications for removal of wounding projectiles in primary and, especially, repeated surgical treatment of craniocerebral wounds is needed.

Predicting early complications in patients with spinal gunshot wounds: A multicenter study

IntroductionThere is a wide variation in the clinical presentation of spinal gunshot wounds ranging from isolated minor stable fractures to extremely severe injuries with catastrophic neurological damage. Research questionwe aim to analyze the risk factors for early complications and impact of surgical treatment in patients with spinal gunshot wounds. Material and methodsThis is a multicentre retrospective case-control study to compare patients with spinal gunshot wounds who had early complications with those who did not. The following matching criteria were used: sex (1:1), injury level (1:1) and age (±5 years). Univariate and multivariate analyses were performed using logistic regression. ResultsResults: Among 387 patients, 36.9 % registered early complications, being persistent pain (n = 32; 15 %), sepsis/septic shock (n = 28; 13 %), pneumonia (n = 27; 13 %) and neurogenic bladder (n = 27; 12 %) the most frequently reported. After case-control matched analysis, we obtained 133 patients who suffered early complications (cases) and 133 patients who did not as control group, not differing significantly in sex (p = 1000), age (p = 0,535) and injury level (p = 1000), while the 35 % of complications group required surgical treatment versus 15 % of the non-complication group (p < 0.001). On multivariable analysis, significant predictors of complications were surgical treatment for spinal injury (OR = 3.50, 95 % CI = 1.68–7.30), dirty wound (3.32, 1.50–7.34), GCS ≤8 (3.56, 1.17–10.79), hemodynamic instability (2.29, 1.07–4.88), and multiple bullets (1.97, 1.05–3.67). Discussion and conclusionSpinal gunshot wounds are associated with a high risk of early complications, especially when spinal surgery is required, and among patients with dirty wound, low level of consciousness, hemodynamic instability, and multiple bullets.