BACKGROUND: To highlight the unique spectrum of hand and upper extremity firearm injuries seen at a rural, Midwestern level 1 trauma center and identify modifiable factors that contribute to firearm injuries of the hand and upper extremity. METHODS: A retrospective review of upper extremity firearm injuries from a rural, Midwestern level 1 trauma center was collected from January 2002 to December 2019. Data acquired included injury description, demographics, injury mechanism/description/location, firearm used, toxicology, and information regarding hospitalization. Data was analyzed using Chi-squared analysis and Fisher's exact test for categorical data and the Wilcoxon rank sum test for continuous data. RESULTS: 55 patients with upper extremity firearm injuries were identified. Average age was 33.3 ± 13.0 years, 81.8% were males, and zero fatalities were identified. 58% (38) of these injuries were unintentional firearm injuries, followed by assaults at 34.6% (19). Law enforcement-related and self-inflicted injuries contributed minimally. Handguns were the most common type of firearm, used in 43.6% of cases. 7.3% (4) of injuries occurred while hunting, with 21.8% (12) total during November or December, the active deer hunting months. 92.7% (51) of all firearm injuries presented with fracture, among which 92.2% (47) met a Gustilo-Anderson classification score of at least 3A. Alcohol was detected in 20% (11) of the patients, while other drugs of abuse were detected in 36.4% (20). CONCLUSION: Our data suggests that upper extremity firearm injuries in a rural population are unique from urban injuries in that they are predominately unintentional, isolated, and non-fatal. We identify a distinct rural cohort that may benefit from better directed interventions to prevent firearm injuries and ultimately guide firearm education and public policy.Level of Evidence: III.
BACKGROUND: To highlight the unique spectrum of hand and upper extremity firearm injuries seen at a rural, Midwestern level 1 trauma center and identify modifiable factors that contribute to firearm injuries of the hand and upper extremity. METHODS: A retrospective review of upper extremity firearm injuries from a rural, Midwestern level 1 trauma center was collected from January 2002 to December 2019. Data acquired included injury description, demographics, injury mechanism/description/location, firearm used, toxicology, and information regarding hospitalization. Data was analyzed using Chi-squared analysis and Fisher's exact test for categorical data and the Wilcoxon rank sum test for continuous data. RESULTS: 55 patients with upper extremity firearm injuries were identified. Average age was 33.3 ± 13.0 years, 81.8% were males, and zero fatalities were identified. 58% (38) of these injuries were unintentional firearm injuries, followed by assaults at 34.6% (19). Law enforcement-related and self-inflicted injuries contributed minimally. Handguns were the most common type of firearm, used in 43.6% of cases. 7.3% (4) of injuries occurred while hunting, with 21.8% (12) total during November or December, the active deer hunting months. 92.7% (51) of all firearm injuries presented with fracture, among which 92.2% (47) met a Gustilo-Anderson classification score of at least 3A. Alcohol was detected in 20% (11) of the patients, while other drugs of abuse were detected in 36.4% (20). CONCLUSION: Our data suggests that upper extremity firearm injuries in a rural population are unique from urban injuries in that they are predominately unintentional, isolated, and non-fatal. We identify a distinct rural cohort that may benefit from better directed interventions to prevent firearm injuries and ultimately guide firearm education and public policy.Level of Evidence: III.
Authors: Charles C Branas; Michael L Nance; Michael R Elliott; Therese S Richmond; C William Schwab Journal: Am J Public Health Date: 2004-10 Impact factor: 9.308
Authors: Brendan G Carr; Michael L Nance; Charles C Branas; Catherine S Wolff; Michael J Kallan; Sage R Myers; Douglas J Wiebe Journal: J Trauma Acute Care Surg Date: 2012-10 Impact factor: 3.313
Authors: Michael L Nance; Lex Denysenko; Dennis R Durbin; Charles C Branas; Perry W Stafford; C William Schwab Journal: Arch Pediatr Adolesc Med Date: 2002-08