The Rurality of Lower Extremity Firearm Injuries.

Background: To highlight the unique spectrum of lower extremity firearm injuries seen at a rural, Midwestern level 1 trauma center to provide insight into prevalence, mechanism of injury, and identify modifiable factors that contribute to firearm injuries of the lower extremity. It is our belief that the creation of our database will help future trauma and firearm databases improve documentation and understand the relationship between anatomic location of injury and outcomes. Methods: A retrospective review of lower extremity firearm injuries from a rural, Midwestern level 1 trauma center was collected from January 2011 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: 69 patients with lower extremity firearm injuries were identified. Average age was 30.14 years, 89.86% were males, and one fatality were identified. 47.83% (33) of these injuries were assaults, followed by unintentional injuries at 42.03% (29). Law enforcement-related and self-inflicted injuries contributed minimally. Handguns were the most common type of firearm, used in 72.5% of cases. Nearly 1/3 of the unintentional firearm injuries occurred during November or December, the active deer hunting months in the community of study. Conclusion: The lower extremity is uniquely vulnerable to both assaults and unintentional injury in our rural environment, differing from what we have previously published regarding the upper extremity. Lower extremity gunshot wounds increased during the winter months, offering a correlation to deer hunting season. Our findings display that not all firearm injuries are created equal, and that there is a need to improve documentation of and additional study in order to optimally tailor firearm prevention measures based on the ruralityurbanicity spectrum. Level of Evidence: III.

The Rurality of Upper Extremity Firearm Injuries.

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.