Evaluation of Self-Inflicted versus Non-Self-Inflicted Gunshot Wounds and Associated Injuries Involving the Hand and...

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Ballistics and Injury Analysis

Background:

• Gunshot wounds (GSWs) incur significant orthopedic costs, estimated at $510 million (2005-2014).
• Existing research highlights differences in injuries from self-inflicted (SI) versus non-self-inflicted (NSI) GSWs, but injury patterns require further elucidation.

Purpose of the Study:

• To analyze and compare injury patterns and outcomes of SI GSWs versus NSI GSWs to the upper extremity.
• To identify factors associated with injury severity and inform trauma management strategies.

Main Methods:

• Retrospective cohort study of upper extremity GSWs from January 2012 to December 2022.
• Statistical analysis included two-sample t-tests, Pearson's chi-squared tests, and Fisher's exact tests.
• Data analyzed for wound characteristics, injury classifications (Gustilo-Anderson, Tscherne), neurovascular damage, fracture rates, and operative intervention.

Main Results:

• SI GSWs were associated with higher velocity (p=0.0014) and distal locations (p<0.0001) compared to NSI GSWs.
• SI GSWs showed higher Gustilo-Anderson (GA) and Tscherne classifications (p<0.0001, p=0.0048) and increased neurovascular damage (p=0.0048).
• No significant differences in fracture rates or need for surgery; however, higher GA/Tscherne classifications correlated with more complex surgical interventions (p<0.0001).

Conclusions:

• The manner of infliction (SI vs. NSI) influences GSW characteristics like velocity and location in the upper extremity.
• Wound grading systems (GA, Tscherne) are critical predictors of surgical complexity, but GSW velocity did not predict the need for surgery.
• Findings support using injury pattern analysis based on infliction manner, velocity, and wound grading for improved trauma care planning and surgical intervention.