How Do Gunshot and Explosive Injuries to the Lower Extremities Differ in Severity and Treatment? A Comparative Study...

Area of Science:

• Trauma surgery
• Orthopedic surgery
• Military medicine

Background:

• Lower extremity injuries are prevalent in conflict trauma.
• Gunshot wounds (GSWs) cause localized damage; explosive trauma results in extensive tissue injury.
• Direct comparisons of injury severity and outcomes between GSWs and explosive trauma are lacking.

Purpose of the Study:

• To compare injury severity (open fractures, neurovascular injuries, amputations) between GSWs and explosive trauma in lower extremities.
• To compare the frequency and types of surgical interventions for GSWs versus explosive trauma.

Main Methods:

• Retrospective analysis of 1318 patients with lower extremity injuries from the Israel National Trauma Registry (October-December 2023).
• Patients were categorized into GSW (53%) and explosive injury (47%) groups.
• Statistical analysis included chi-square and independent t-tests (p < 0.01).

Main Results:

• GSWs had higher rates of open fractures (32% vs. 20%, p=0.001), especially in tibia/fibula.
• Explosive injuries resulted in more amputations (10% vs. 3%, p<0.001).
• Surgical intervention was more frequent for GSWs (73% vs. 59%, p<0.001).

Conclusions:

• Distinct injury patterns necessitate tailored trauma care strategies.
• Prioritize early rehabilitation for blast injuries due to high amputation rates.
• Focus on orthopedic fixation and infection control for GSW open fractures; emphasize early surgery for GSWs and hemorrhage control for blast injuries.