Treatment of tibial bone defects with the Ilizarov circular external fixator in high-velocity gunshot wounds.
One of the applications for circular external fixators is the treatment of large-bone defects which may be difficult to manage with conventional methods. Successful results have been reported with the use of circular external fixators, particularly in the treatment of infected tibial pseudoarthroses and those with bone loss. In this study, a total of 43 cases with tibial bone defects (18 infected) as a result of high-velocity gun-shot injuries were treated with circular external fixators between January 1, 1988 and December 31, 1995. The mean follow-up period was 50 months (range: 28-98 months) after the removal of the Ilizarov device. Satisfactory union was obtained in 40 cases without any major complication or additional surgical intervention, in spite of the large and in some cases infected defects. We conclude that this is a safe method for the treatment of infected or noninfected tibial bone defects. (+info
Calcific myonecrosis is a rare and late sequela of compartment syndrome, which becomes symptomatic years after the initial trauma. We diagnosed this condition in a 64-year old man, 42 years after he sustained a shot-gun wound to the right lower leg. Total excision of a peripherally calcified, cystic mass, continuous with the anterior tibial muscle belly resulted in complete resolution of symptoms. Consideration of the diagnosis is warranted in patients with a history of major injury who develop a soft tissue mass in the traumatized compartment. The treatment of choice is marginal excision. (+info
Child and adolescent injury and death from urban firearm assaults: association with age, race, and poverty.
OBJECTIVE: To describe rates and trends in the incidence of non-fatal and fatal firearm assault among children (16 years old or younger) over an 11 year period in Chicago, Illinois and to identify the socioeconomic characteristics of community areas where assaults are common. METHODS: The Chicago Police Department (CPD) records from 1986 through 1996 were reviewed for children assaulted with a firearm. United States census data for 1990 for Chicago were used to calculate incidence rates; census data were also used for community area (defined by census tract) socioeconomic descriptions. RESULTS: The CPD recorded 11,163 pediatric firearm assaults during the study period: 10,571 non-fatal and 592 (5%) fatal. From 1986 through 1996 non-fatal assaults more than doubled, with the highest rates in 1994; fatal assaults tripled, with rates peaking in 1993-94. Significant increases in non-fatal firearm assaults occurred among black and Hispanic males and females. In 1994, compared with white males, the relative risk of non-fatal assault was 7.0 (95% confidence interval (CI) 5.3 to 9.1) for black males and 3.3 (95% CI 2.5 to 4.4) for Hispanic males; the relative risk was 1.5 (95% CI 1.1 to 2.1) for black females. A handgun was the firearm used in most assaults (88% of non-fatal and 84% of fatal). Within community areas, the correlation between non-fatal and fatal assault incidence was strong (r=0.80, p<0.001). The proportion of families with income below the 1989 poverty level ($12,674) and the per cent black race in the community area together accounted for 70% of the variance in assault rates. CONCLUSIONS: From 1986 to 1994 there were significant increases in both non-fatal and fatal firearm assaults, usually by handguns; thereafter, rates declined. Urban children who were victims of non-fatal firearm assault appear to come from the same population as those who suffer fatal assaults. Black and Hispanic youth living in poverty were at particular risk. (+info
Pediatric practice based evaluation of the Steps to Prevent Firearm Injury program.
OBJECTIVE: To estimate the prevalence of gun ownership and methods of gun storage in homes of pediatric patients before and after an educational intervention. DESIGN: Before and after trial. SETTING: Hospital based, inner city, pediatric primary care practice. PARTICIPANTS: Consecutive sample of parents of patients with appointments August to November 1994. INTERVENTION: Before the intervention, participants completed an anonymous questionnaire regarding ownership and storage of guns in their home. The intervention followed the Steps to Prevent Firearm Injury program of the American Academy of Pediatrics. It began after the parent completed the questionnaire and was reinforced at subsequent visits until July 1995. Families completing a baseline questionnaire and returning to the office July to October 1995 were resurveyed. MAIN OUTCOME MEASURE: Reported change in gun ownership and methods of storage. RESULTS: A gun(s) in the home was reported by 8.7% of respondents. Matched baseline and follow up questionnaires were available for 23.6% of families. In these, gun ownership reportedly decreased after intervention from 9.4% to 7.0%, handgun ownership fell from 5.4% to 3.0%, and long gun ownership fell from 6.1% to 5.5%. Storing guns outside of a locked container did not change from the baseline prevalence of 2.7%, but keeping any gun loaded fell from 1.6% to 0.5%. All p values were >0.05. CONCLUSION: This study was unable to demonstrate a statistically significant decline in gun ownership or improvement in gun storage after a practice based intervention designed to encourage these behaviors. (+info
Universal primary colonic repair in the firearm era.
All patients with colonic trauma treated at King Edward VIII Hospital, Durban, from August 1993 to May 1994 underwent primary repair of the colonic wound. They were evaluated prospectively to assess the mode of injury and outcome variables. Colonic injuries were sustained by 102 patients. These were inflicted by gunshots (62), stabs (22), shotguns (14), and blunt trauma (4). The transverse colon was injured most frequently (53). All shotgun injuries were multiple. Average time from admission to theatre was similar for shocked and non-shocked patients. Eighty-seven patients had simple closure (18 deaths) and 15 required resection and anastomosis (eight deaths). Ten patients died in the first 48 h, and 16 died subsequently owing to multiple-organ systems dysfunction. The mortality rates were stabs 9% (2), gunshots 27% (17), shotguns 50% (7), and 0% for blunt trauma. Septic morbidity was seen in 16 but was not related to breakdown of the colonic repair. Implementation of strategies to reduce preoperative time delays and use damage control principles for the management of massive trauma should be evaluated as methods of reducing mortality. (+info
Experimental study on firearm wound in maxillofacial region.
OBJECTIVE: To make clear the range of firearm wound in the maxillofacial region, the optical repair time and the characteristics of accompanied indirect brain damage, and to offer the principle of emergency treatment and the early repair of war wound. METHODS: With the aid of the standard Sweden model, 200 dogs were used in the experiment. Varies tissues around the primary canal were harvested chronologically, in different zone and different tissue, for histopathological examination. RESULTS: The necrotic range of various tissues in the maxillofacial region was less than that in the extremities. In the maxillofacial region, there was a significant temporary cavity following the passing of bullet, which caused indirect brain damages. CONCLUSION: These findings are helpful to the treatment of war wound in the maxillofacial region. Early bone transplantation using microvascular anastomosis in the treatment of gunshot wound in the maxillofacial region is recommendable. (+info
Handguns as a pediatric problem. 1986.
Handgun injury is a major cause of morbidity and mortality in American society, particularly for young people. Large numbers of children are affected by handgun violence through the loss of fathers, brothers, and other relatives. Young children are injured and sometimes killed in handgun accidents. Some children and many adolescents are murdered with handguns. Because of their great lethality and very limited ability to provide personal protection, the great burden of handgun injury can best be reduced by making handguns less available. Handgun control cannot reduce rates of crime or interpersonal assault, but it can be expected to reduce the frequency and severity of injury which grows out of these situations, to levels closer to the much lower ones found in other countries. Pediatricians can contribute to this effort, as they have to the efforts to reduce the morbidity and mortality from poisonings and motor vehicle passenger injury. (+info
Firearm-associated deaths and hospitalizations--California, 1995-1996.
During 1995-1996, 27% of recorded injury-related deaths in California involved firearms (California Department of Health Services [CDHS], unpublished data, 1995-1996). In 1996, CDHS began passive surveillance of "severe" firearm-related injuries (i.e., resulting in death or hospitalization) with resources provided by the California Wellness Foundation. To characterize firearm-related injuries in California, CDHS analyzed death records and hospital discharge records for 1995 and 1996 (the most recent years for which population data are available to calculate rates). This report summarizes the results of the analysis, which indicate that most of the 21,985 firearm-related injuries and deaths resulted from assault. (+info