Outcomes of complex gunshot wounds to the hand and wrist: A 10-year level i urban trauma center experience

Clifford Pereira, J. Brian Boyd, Aviva Olsavski, Mark Gelfand, Brant Putnam

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

PURPOSE: To assess the consequences of gunshot wounds (GSWs) to the hand, we reviewed our 10-year experience at an urban level I trauma center. METHOD: A retrospective review was performed on patients admitted with GSWs to the extremities between January 1, 1997 and January 1, 2007. Those with GSWs to the hand and wrist needing surgery were studied. A telephone survey supplemented the data. RESULTS: Of 1358 patients admitted with GSWs involving the upper extremities, 62 patients with complex hand and wrist injuries requiring operative intervention were identified. Most patients sustained low-velocity handgun injuries and presented within 12 hours of injury. In many individuals (97%), the gunshot injury to the hand or wrist was only part of a multiple gunshot assault. All patients underwent surgical debridement and repair followed by an early aggressive rehabilitation program. Mean length of hospital stay was 5.0 (±5.1) days, with 9.7% of patients requiring ICU care for 3.3 (±1.4) days, with an average cost of $47,819 (±$53, 548) per patient. Although 65% of the individuals subsequently reported being "disabled from work" due to pain, the quality of life, and ultimate function was good in 61%, fair in 26.1%, and bad in 13%. CONCLUSION: GSWs to the hand and wrist are often part of multiple handgun wounds in one individual. Most produce comminuted fractures, seldom requiring bone grafts, fusion, or amputation. Vascular injuries, though rare, necessitate vein grafts due to loss of length. Few patients require free flaps, and few sustain nerve or tendon injuries. Most complain of pain or numbness. However, a good quality of life and a return to the activities of daily living occurred in two-third individuals.

Original languageEnglish (US)
Pages (from-to)374-377
Number of pages4
JournalAnnals of Plastic Surgery
Volume68
Issue number4
DOIs
StatePublished - Apr 1 2012

Fingerprint

Gunshot Wounds
Trauma Centers
antineoplaston A10
Wrist
Hand
Wrist Injuries
Hand Injuries
Length of Stay
Quality of Life
Comminuted Fractures
Tendon Injuries
Transplants
Pain
Hypesthesia
Free Tissue Flaps
Multiple Trauma
Vascular System Injuries
Wounds and Injuries
Debridement
Activities of Daily Living

Keywords

  • epidemiology
  • gunshot wounds
  • hand
  • management
  • outcome
  • reconstruction
  • wrist

ASJC Scopus subject areas

  • Surgery

Cite this

Outcomes of complex gunshot wounds to the hand and wrist : A 10-year level i urban trauma center experience. / Pereira, Clifford; Boyd, J. Brian; Olsavski, Aviva; Gelfand, Mark; Putnam, Brant.

In: Annals of Plastic Surgery, Vol. 68, No. 4, 01.04.2012, p. 374-377.

Research output: Contribution to journalArticle

Pereira, Clifford ; Boyd, J. Brian ; Olsavski, Aviva ; Gelfand, Mark ; Putnam, Brant. / Outcomes of complex gunshot wounds to the hand and wrist : A 10-year level i urban trauma center experience. In: Annals of Plastic Surgery. 2012 ; Vol. 68, No. 4. pp. 374-377.
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AB - PURPOSE: To assess the consequences of gunshot wounds (GSWs) to the hand, we reviewed our 10-year experience at an urban level I trauma center. METHOD: A retrospective review was performed on patients admitted with GSWs to the extremities between January 1, 1997 and January 1, 2007. Those with GSWs to the hand and wrist needing surgery were studied. A telephone survey supplemented the data. RESULTS: Of 1358 patients admitted with GSWs involving the upper extremities, 62 patients with complex hand and wrist injuries requiring operative intervention were identified. Most patients sustained low-velocity handgun injuries and presented within 12 hours of injury. In many individuals (97%), the gunshot injury to the hand or wrist was only part of a multiple gunshot assault. All patients underwent surgical debridement and repair followed by an early aggressive rehabilitation program. Mean length of hospital stay was 5.0 (±5.1) days, with 9.7% of patients requiring ICU care for 3.3 (±1.4) days, with an average cost of $47,819 (±$53, 548) per patient. Although 65% of the individuals subsequently reported being "disabled from work" due to pain, the quality of life, and ultimate function was good in 61%, fair in 26.1%, and bad in 13%. CONCLUSION: GSWs to the hand and wrist are often part of multiple handgun wounds in one individual. Most produce comminuted fractures, seldom requiring bone grafts, fusion, or amputation. Vascular injuries, though rare, necessitate vein grafts due to loss of length. Few patients require free flaps, and few sustain nerve or tendon injuries. Most complain of pain or numbness. However, a good quality of life and a return to the activities of daily living occurred in two-third individuals.

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