Gunshot injury in children: A 3-year review of cases that presented to the Jos University Teaching Hospital, North Central Nigeria

OBJECTIVES: Gunshot injuries among children are a major clinical and public health concern and one of the leading causes of pediatric morbidity and mortality. This usually takes a great financial and emotional toll on the affected children, their families, and society as a whole. The objective of the study was to determine the pattern of injury, severity, outcome, and challenges in managing the gunshot injuries in children.MATERIAL AND METHODS: This is a descriptive study of patients below 18 years of age who presented with gunshot injuries to the Jos University Teaching Hospital between January 2011 and December 2014. Patient demographics and clinical details were collected on a trauma data sheet, and entered into an Excel spreadsheet. It was analyzed descriptively.RESULTS: Two hundred and forty-two patients presented with gunshot injuries in the period under review, of which 30 of them were children. The median age of the patients was 12 years with an interquartile range of 7.75 and 16.25. Twenty-two (73.3%) of them were male while 8 (26.7%) were female. High-velocity firearms accounted for 13 (43.3%) of the injuries and were the most predominant cause of injury. The most common part of the body involved was the extremities in 63.3% of patients. Debridement and secondary suturing was carried out in 83.3% of the patients while wound infection was the most noted complication in 33.3% of the patients. CONCLUSION:There is an increasing incidence of gunshot injuries in this region. A lot of the children survive and reach the hospital though, and most of them are treated and discharged, however, attendant emotional and psychological trauma cannot be excluded in these patients. There is, thus, a need for proper policy to protect and treat these children when this happens.

Transcranial lateral perforating gunshot injury through skull base presenting without residual damage: A fortunate survivor / 中华创伤杂志(英文版)

We reported a case of a 32 years old male presenting with a perforating gunshot injury in craniocerebral region 3 h after the assault. The bullet entered above the right zygomatic arch, travelling through the coronal plane, and exited from the left zygomatic arch. The patient was fully conscious at presentation and developed facial nerve palsy during his hospital stay. Non-contrast CT scan of the head revealed fractures of the right orbit, bilateral maxilla, bilateral pterygoid plates, ethmoid air cells, vomer and left zygoma, and without any cerebral damage. He was treated conservatively and the facial palsy was resolved. The patient survived without any complications. Such case has not been described in the available literature till date.

Early changes of coagulation function in a swine traumatic model within 1 hour after traumatic hemorrhagic shock induced by Gunshot injury / 解放军医学杂志

Objective To explore the potential mechanism of traumatic coagulopathy through investigating the periodic change of hemodynamics, acid-base system, and coagulation system within 1 hour after traumatic hemorrhagic shock. Methods Adult healthy Landrace pigs were anesthetized to establish a model of hemorrhagic shock-induced by gunshot wounds. Vital signs, Hemodynamic parameters were monitored, and arterial blood gas, routine coagulation as well as thromboelastogram were tested at 15 minutes before the injury, shock point, 10 minutes after the shock, 30 minutes after the shock, and 1 hour after the shock, respectively. Results Among the 16 Landrace pigs that were examined, the mean total blood loss was (1444.22±205.50) ml with a 1-hour survival rate of 68.75%. Among the 11 pigs which survived over 1 hour, Hemodynamic and arterial blood gas analysis showed characteristics of stages. Analysis coagulation test showed that R value, PT and APTT are periodically decreased. The MA value decreased significantly from injury to 10 minutes after shock point (P<0.05), and LY30 showed a significant decreased from 10 minutes aftershock to 1-hour aftershock (P=0.038). In the correlation analysis of coagulation changes, there was a correlation between APTT value and heart rate, diastolic blood pressure, systolic blood pressure, MAP (P<0.05); R value was related to heart rate, SVI, systolic blood pressure, and MAP (P<0.05); MA value was related to BE, LAC, K+, PH, Ca2+, and SVI (P<0.05). Conclusion Within 1 hour after severe traumatic hemorrhagic shock, the coagulation system is in a hypercoagulable state. At 10 minutes after the shock, the fibrinolytic system is inhibited and the fibrinolysis is shut down, which may further aggravate the hypercoagulable state.

Gunshot injury to spine: An institutional experience of management and complications from a developing country / 中华创伤杂志(英文版)

PURPOSE@#Gunshot wounds are the second leading cause of spinal cord injuries. Surgical intervention for gunshot injury to the spine carries a high rate of complications. There is a scarcity of data on civilian gunshot injuries to the spine in Pakistan. Approximately 60 cases over the last 10 years have been recoded, with unusual presentation and neurological recovery. Thus it is imperative to fill this gap in data, by reviewing cases of civilian gunshot injuries to spine presenting at a tertiary care hospital (Aga Khan University Hospital, Karachi).@*METHODS@#This is a retrospective cohort study. Patients of all ages who presented to the emergency department of Aga Khan University Hospital, with gunshot injuries to spine between January 2005 and December 2016 were included in the study. Data were collected on neurological status (American Spinal Injury Association score was used for the initial and follow-up neurological assessment), extent of cord transection, motor and sensory deficits. The patients were further grouped into those with cord transection, and those with fractures of the bony spine but an intact spinal cord. These patients were then followed and the outcomes were recorded.@*RESULTS@#A total of 40 patients were identified. The mean ± SD of patients age was (30.9 ± 9.5) years. Of the 40 patients with gunshot wounds, 31 had the medical imaging performed at the facility, and hence they were included in this categorization. The remaining 9 patients were excluded from this additional grouping. Thirteen patients were managed surgically and 27 patients underwent the conservative management. The mean ± SD of follow-up was (8.7 ± 7.2) months. In our study, the thoracic spine was the most commonly injured region in gunshot injuries. Of the 31 patients with medical imaging performed at our institute, 17 (54.8%) had cord transection, of whom 8 (47%) ultimately developed paraplegia.@*CONCLUSION@#The prognosis of gunshot injuries to the spine can be varied depending on whether the spinal cord is intact or transected. This will help healthcare providers to plan the further management of the patient and counsel them accordingly.

Surgical correction of severe enophthalmos caused by bullet injury.

Ballistic injuries of oral and maxillofacial region are usually fatal due to close propinquity with the vital structures. The severity of injury depends on the caliber of the weapon used and distance from which the patient is shot. The preliminary care of facial ballistic wounds strictly adheres to the basics of trauma resuscitation. Early and appropriate surgical management has proved to be influential on the final outcome and esthetic result. Treatment of facial gunshot wounds should be planned and carried out carefully to avoid esthetic complications. It takes even multiple‑staged corrections to achieve the targeted functional and esthetic treatment plan. Prevention and control of infection is one of the most important goals to achieve the success of the treatment. Herewith, we present a case of facial gunshot injury with fractures in the orbital floor, medial wall maxillary sinus, and buttress of the zygomatic bone causing deficit, which was successfully managed by surgical reconstruction.

Retained Intraspinal Bullet: A Rare Case in a Visitor to Malaysia - A Case Report

Firearm injuries to the spine commonly present with acute neurology caused by direct penetration or indirectly from concussive effects of bullet impact on the vertebral column. We report a case of delayed neurologic presentation of retained intra-spinal bullet in a 42 year-old African who had chronic low back pain and sciatica with a past history of gunshot injury to the spine and radiograph revealed a bullet at the L4-5 disc level. Intra-operative exploration showed a fibrous mass around the bullet compressing on the L4 existing nerve root and L5 traversing nerve root. Removal of the retained bullet resulted in a good clinical outcome with complete resolution of symptoms.

Gunshot Injury to the Anterior Arch of Atlas

Penetrating injuries to the upper cervical spine resulting from gunshots are rare in South Korea due to restrictions of gun use. Moreover, gunshot wounds to the upper cervical spine without neurological deficits occur infrequently because of the anatomic location and surrounding essential structures. We present an uncommon case involving the surgical removal of a bullet located in the anterior arch of first cervical vertebra (C1) via a transoral approach without neurological complications or subsequent mechanical instability.

Bacterial Infection after Gunshot Injury in Chongqing and Lasa:A Comparative Study / 中华医院感染学杂志

OBJECTIVE To observe Staphylococcus aureus(SAU) infection at high altitude and plain after gunshot injury. METHODS Used 7.62mm bullets to injure posterior limbs of piglets with the same age.We got contusing tissues in different time after injury,to make bacteriologic examination,identify and make a statistic analysis of SAU. RESULTS The main infection was caused by SAU after gunshot injury in two regions.From contusing tissues in two regions,the rate of contamination caused by SAU in Chongqing and Lasa was 48% and 18%,respectively.The time of SAU colonization was 3 hours at high altitude,and less 3 hours at plain.The velocity of reproduction of SAU at high altitude for 12 hours was 5-6 passages,and at plain was 4-6 passages for 3-6h.The time of remaining relative steady state between tissues and germs was 48 hours at high aititude and 24 hours at plain.The difference of the number of SAU between two regions after injury 3-36 hours was significant,But after 36 hours the difference was unsignificant. CONCLUSIONS At high altitude region,SAU is the main germ that causes contamination after gunshot injury,the velocity of reproduction of SAU is slower than that at plain,the time of infection is delayed obviously.

Stereotactic Surgery for the Nail-Gun Injury of the Head: Case Report

The authors report a rare case of gunshot injury to the head by a nail-gun which was treated by stereotactic surgery. In the case, a 23-year-old male patient, presented with semicomatose mentality and decerebrated rigidity. The large nail was located in the 3rd ventricular area in the mid-line with vertical stature. The entry point was identified 1cm anterior to the coronal suture line and just lateral to the sagittal suture line. The foreign body was removed stereotactically with the guidance of gluoroscope. But the died of initial severe brain damage.

GUN-SHOT INJURIES OF MANDIBLE AND SOFT TISSUES: EARLY-STAGE REPAIR AND HISTOIOPATHOLO-GICAL CHANGES / 第二军医大学学报

The purpose of this study was to determine the debriding scope of soft tissues in gunshot wound, and to compare the feasibility of one-stage bone graft transfer between nonvascularized and vascularized bone grafts in 16 dogs.The results demonstrated that it was not accurate to excise the soft tissue till bleeding or to excise only 1cm around the trajectory.The major reasons for the failure of bone transplantation were wound infection, oral open wound, and subsequent infectious myelitis and formation of fistula.Both the nonvascularized and vascularized bone grafts survived at the early stage.The transplanted bone served as bone bridge, and induced the formation of new bone.The bone defect was repaired by membranous bone formation.

A Case of Renocolic Fistula and Intrarenal Aneurysm by Gunshot Wound / 대한비뇨기과학회지

Renal injury inflicted by high-velocity missiles is serious because of the wide spread blast injury to tissue. Blast effect may lead to a secondary tissue necrosis with hemorrhage, fistula and infection. Recently we experienced one case of bilateral injury by gunshot complicated by renocolic fistula and intrarenal aneurysm. Management of delayed sequale of renal injury was presentedand discussed.

EXPERIMENTAL STUDY ON GUNSHOT CONCUSSION OF PERIPHERAL NERVE / 解放军医学杂志

Concussion injuries of peripheral nerves are frequently encountered in gunshot wounds of extremities. With the aid of high speed X-ray imaging technic, the sciatic nerves of dogs were visualized continuously during the formation of the temporary cavitation when a high-velocity of bullet was shot into the thigh.It was concluded that the concussional injury of the nerve was the result of a combination of stretching, compression, and concussion. There was a exponential correlation among cavity volume, absorption of energy and nerve displacement. The pathological changes included extensive microvascular injury and partial breakage of nerve fibres. Extensiveness and lack of uniformity in pathological changes may have some clinical implications.