title: Orthopaedic firearm injuries in children and adolescents: An eight-year experience at a major urban trauma center.
abstract: BACKGROUND
  The purpose of this study is to describe the epidemiology of orthopaedic injuries incurred secondary to firearms among children and adolescents at a major metropolitan trauma center and to identify risk factors for complications and long-term morbidity.
  
  
  METHODS
  A retrospective review was performed of consecutive patients 17 years of age and younger who sustained a firearm injury and required orthopaedic treatment at a major trauma center from 2006 to 2013. Patient demographics, injury mechanism, fracture classification, neurovascular injury, antibiotic administration, and length of hospitalization were recorded. Radiographic studies were used to determine fracture pattern, methods of stabilization, and time to union. Primary clinical outcomes include fracture nonunion, infection, and physeal arrest.
  
  
  RESULTS
  46 patients with a mean age of 12.7 years were treated for firearm related orthopaedic injuries. 72% of the patients were ages 13-17, while 28% were 12 years of age and younger. There were 28 violent injuries (21 assaults, 7 innocent bystanders) and 16 non-violent injuries (15 unintentional discharges and 1 self-inflicted). There was a bimodal distribution of violent versus nonviolent mechanisms, with the majority of children 12 years of age and under sustaining non-violent injuries and adolescents more commonly injured with a violent mechanism. There were 44 fractures and 6 traumatic arthrotomies, with eight associated neurovascular injuries. Twenty-five patients had an orthopaedic procedure, with a total of 43 surgeries. Mean hospital length of stay was 6.8 days. There were five deep infections. Four patients developed non-unions and all of these patients had deep infections. The timing and duration of antibiotic therapy was not significantly different between those who did and did not develop infection. Of the non-operatively treated fractures, there were no infections or non-unions at long-term follow-up.
  
  
  CONCLUSIONS
  Morbidity and mortality related to firearms is a growing public health problem in the United States. Results of this study suggest that gunshot related fractures had higher than anticipated morbidity, including permanent neurologic deficits, infection (11%) and fracture non-union (9%). More than half of patients underwent surgery and experienced long hospital stays secondary to the complexity of the injury. This epidemiological data on firearm injuries in children and adolescents is an impetus for prospective study, with the goal to increase awareness and develop treatment strategies for firearm-related fractures.
authors.affiliation: Department of Orthopaedic Surgery, Carolinas Medical Center, United States.
authors.forename: Crystal
authors.initials: C
authors.lastname: Perkins
authors.affiliation: Department of Orthopaedic Surgery, Carolinas Medical Center, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: Scannell
authors.affiliation: Department of Orthopaedic Surgery, Carolinas Medical Center, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: Brighton
authors.affiliation: Department of Orthopaedic Surgery, Carolinas Medical Center, United States.
authors.forename: Rachel
authors.initials: R
authors.lastname: Seymour
authors.affiliation: Department of Orthopaedic Surgery, Carolinas Medical Center, United States. Electronic address: kelly.vanderhave@carolinashealthcare.org.
authors.forename: Kelly
authors.initials: K
authors.lastname: Vanderhave
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D057772:Vascular System Injuries / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D014948:Wounds, Gunshot / Q000150:complications / Q000453:epidemiology* / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents
keywords: Fracture; Gun violence; Infection; Injury prevention; Orthopaedics; Paediatrics