Gunshot injuries to the extremities: experience of a U.K. trauma centre
Introduction
Gunshot injuries have become increasingly common in most countries particularly the United States of America.5 In the United Kingdom there has been an approximately 30% increase in firearm associated crime over the period 1998–2002 as reported by the Metropolitan Police (Scheme 1). Firearm crimes and associated injuries are given liberal media coverage in the U.K. leading to the perception of an increase in the incidence of cases of firearm injuries an orthopaedic surgeon might see. Numerous papers are found in the literature concentrating on gunshot injuries to the extremities but almost all of these originate in the U.S.A.1, 2, 4, 6, 7, 9
The complications associated with these injuries tend to be related to the degree of energy transfer3 and include wound infection, neurovascular injury, compartment syndrome, delayed union and non-union of fractures.
In the U.S.A. gunshot-related injuries are the leading cause of death in male African-American teenagers.1 In the United Kingdom it is a commonly held preconception that these injuries tend to predominate among the Afro-Caribbean population and that the management of these patients is challenging due to non-compliance to treatment.
Our aim is to report on (i) the yearly incidence of gunshot injuries to the extremity over a five-year period, (ii) complications seen using a basic treatment algorithm, and (iii) our experience in treating the victims of gunshot injuries to the extremity from a U.K. centre treating a multicultural urban population in South East London.
Section snippets
Patients and methods
Patients presenting with extremity gunshot wounds to our hospital were routinely referred for an orthopaedic assessment by the Accident and Emergency department. Over a five-year period (1998–2002) all cases of extremity gunshot wounds were identified from an orthopaedic trauma register and case notes were reviewed retrospectively.
The yearly incidence of gunshot injuries was correlated with Metropolitan Police figures.
To identify the type of injury and associated complications, the following
Results
A total of 70 gunshot wounds in 61 patients were seen during the five-year period. Sex distribution was 49 male and 12 female patients. The ages of the patients ranged from 9 to 45 years (mean 26.7; S.D. 7.5).
The ethnic distribution of the victims is shown in Scheme 2a. This is compared to the distribution of our age-matched catchment population (Scheme 2b).
Of the 61 cases the victim–assailant distance was recorded in 46 cases and of these no wounds were inflicted from more than 20 feet and the
Discussion
The incidence of gunshot injuries and gun related crime appears to be increasing in the United Kingdom. This is the perception given by the media, “Police fear they are losing control of gun-crazy Britain”-The Observer-5th Oct. 03.These gun-crime-related headlines are not unusual in our daily newspapers at present. In addition, gunshot injuries are being reported in areas where this was previously unheard of, e.g., Nottingham.
We have seen a nearly four-fold increase in the incidence over the
Conclusion
Based on our experience, we have shown that:
- (1)
The incidence of gunshot injuries is on the increase in the United Kingdom.
- (2)
The complications associated with these injuries can be reduced to a minimum if the basic principles of management are strictly adhered to.
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