Firearm-Related Upper-Limb Injuries in Children: An 8-Year Single Institution Analysis

Pediatric firearm-related injuries are rising, reflecting an ongoing public health concern and burden on the health care system. However, studies examining regional gunshot wound (GSW) trends among children are scarce. We evaluated upper-limb injuries from GSWs at our state's sole level-1 trauma center over 8 years. We hypothesize there would be an increase in upper limb ballistic injuries in our pediatric population and that understanding these trends may lead to improved supportive care and interventions aimed at mitigating future occurrences.

A retrospective chart review of pediatric patients (age <18) referred for GSW-related injuries to the upper extremity from 2016 to 2023 was conducted. Data collected included patient demographics, injury characteristics, fracture locations, surgical management, and long-term complications. Trends and disparities were analyzed.

Of the 296 total patients with nonfatal pediatric firearm injuries, 58 patients sustained GSW-related to the upper limb (19.6%). Forty-two of these 58 patients (68.9%) had fractures. Most patients were men (79.3%) and Hispanic/Latino (65.5%) with a mean age of 15.2 years (range 6-17 years). The phalanx (n = 11) and humerus (n = 10) were the most commonly fractured bones. 62.1% (n = 36) of patients required operative management, 20 of which involved fracture fixation. Antibiotic administration was noted in 86.2% of patients, predominantly cefazolin. We observed primary sequelae, which included 15 nerve injuries and 42 fractures. Documented soft tissue infections occurred in 9.4% of patients. Over 37% of patients lived in impoverished areas.

Pediatric gunshot injuries remain a notable concern with broad implications for medical care and public health. We identified a total of 296 pediatric patients with nonfatal firearm-related injuries in 8 years, 58 of which involved injuries to the upper limb. Orthopedic surgeons have a role in recognizing this epidemic, improving treatment protocols, and providing guidance for practical improvements in education in injury prevention.

IV (case series).