title: Extremity firearm trauma: the impact of injury pattern on clinical outcomes.
abstract: As a group, the extremities are the most commonly injured anatomic region in nonfatal firearm trauma and are associated with high rates of vascular and bony injury. This study examines the epidemiology, incidence and distribution of firearm-related extremity trauma and the relationship  between injury pattern and local or systemic complications. Review of the National Trauma Databank identified 6987 patients with isolated extremity firearm injury. Epidemiologic data, injury pattern incidence, and local and systemic complications were reviewed. Multivariate analysis identified  the impact of extremity injury pattern on complications. Overall fracture incidence was 22 per cent. Fracture was associated with both vascular (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.5 to 2.4; P < 0.001) and nerve injury (OR, 2.6; 95% CI, 1.9 to 3.5; P <  0.001). Isolated fracture increased risk of compartment syndrome (OR, 2.4; 95% CI, 1.1 to 5.3; P = 0.035). Vascular injury alone increased the risk of compartment syndrome (OR, 11.5; 95% CI, 5.0 to 26.2; P < 0.001) and deep venous thrombosis (OR, 7.9; 95% CI, 2.5 to 25.2;  P < 0.001). Fracture and vascular injury together also increased risk of wound infection (OR, 9.7; 95% CI, 3.9 to 23.4; P < 0.001). In patients with extremity trauma, the injury pattern significantly impacts local but not systemic complication rates. Gunshot-related fracture,  occurring in one-fifth of patients, increases the risk of vascular and nerve injury. Vascular injury, with or without fracture, is the biggest predictor of local complications.
authors.affiliation: Los Angeles County + University of Southern California Medical Center, Division of Trauma Surgery and Surgical Critical Care, Los Angeles, California, USA.
authors.forename: Regan J
authors.initials: RJ
authors.lastname: Berg
authors.forename: Obi
authors.initials: O
authors.lastname: Okoye
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Agathoklis
authors.initials: A
authors.lastname: Konstantinidis
authors.forename: Bernardino
authors.initials: B
authors.lastname: Branco
authors.forename: Erin
authors.initials: E
authors.lastname: Meisel
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001134:Arm Injuries / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D016001:Confidence Intervals; D016208:Databases, Factual; D005121:Extremities / Q000293:injuries*; D005260:Female; D005389:Firearms; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007869:Leg Injuries / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate; D014193:Trauma Centers; D057772:Vascular System Injuries / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D014948:Wounds, Gunshot / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology*; D055815:Young Adult