Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Nov 9, 2021; 10(6): 151-158
Published online Nov 9, 2021. doi: 10.5409/wjcp.v10.i6.151
Pediatric firearm-associated fractures: Analysis of management and outcomes
Virginia Lieu, Laura A Carrillo, Nirav K Pandya, Ishaan Swarup
Virginia Lieu, Department of Orthopaedics, St. Mary’s Medical Center, San Francisco, CA 94117, United States
Laura A Carrillo, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Nirav K Pandya, Ishaan Swarup, Department of Orthopaedics, UCSF Benioff Children’s Hospital Oakland, Oakland, CA 94609, United States
Author contributions: Swarup I designed the research and supervised and contributed to the report; Pandya NK supervised and contributed to the report; Lieu V and Carrillo LA collected and analyzed the data and wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board at UCSF Benioff Children’s Hospital Oakland.
Informed consent statement: The informed consent statement was waived by the Institutional Review Board.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ishaan Swarup, MD, Assistant Professor, Department of Orthopaedics, UCSF Benioff Children’s Hospital Oakland, 744 52nd Street, Oakland, CA 94609, United States. ishaan.swarup@ucsf.edu
Received: January 7, 2021
Peer-review started: January 7, 2021
First decision: May 6, 2021
Revised: June 7, 2021
Accepted: September 22, 2021
Article in press: September 22, 2021
Published online: November 9, 2021
Processing time: 305 Days and 14.4 Hours
Abstract
BACKGROUND

Firearm-associated injuries (FAIs) are among the leading causes of morbidity and mortality in children living in the United States. Most victims of such injuries survive, but may experience compromised function related to musculoskeletal injuries. Although complex firearm-associated fractures (FAFs) often require specialized orthopaedic, vascular, and plastic surgical intervention, there is minimal research describing their management and outcomes. The purpose of this study is to describe the epidemiology and presentation of pediatric FAFs, as well as evaluate the management and outcomes of these injuries.

AIM

To describe the epidemiology and presentation of pediatric FAFs, as well as evaluate the management and outcomes of these injuries.

METHODS

A retrospective chart review was performed at a major, pediatric level 1 trauma center. The study included patients aged 18 or younger who presented with FAIs between 2008-2018. Additional data was collected on patients with FAFs including demographic and clinical data such as age, sex, race, payor type, fracture location, injury severity score (ISS), and radiographic and clinical outcomes. The management of FAFs was analyzed as well as need for readmission and reoperation. Descriptive statistics were used to summarize the results and univariate analyses were performed to assess differences between groups.

RESULTS

Between 2008 and 2018, there were a total of 61 patients who presented with FAIs. In this cohort, 21 patients (34%) sustained FAFs (25 fractures) with a mean age of 11 (Range: 10 mo to 18 years old) at the time of presentation. Approximately 52% (n = 11) of patients with FAFs were male, 76% (n = 8 and n = 8, respectively) identified as black or other, and 71% (n = 15) had government insurance. FAFs were most commonly noted in the upper extremity (n = 7) and lower extremity (n = 6). In patients with FAFs, the mean ISS at presentation was 11.38 (Range: 2-38), and 24% of patients (n = 5) were classified as having a major trauma. There were no significant differences in age, sex, race, and payor type in FAF patients that presented with and without major trauma (P > 0.05). When comparing FAF and non-FAF patients, there was a statistically significant difference in ISS (11.38 vs 14.45, P = 0.02). In total, 33% (n = 7) of patients with FAFs required orthopaedic surgical management, which was most commonly comprised of debridement (n = 6/7, 86%), and 14% (n = 1/7) of these patients required coordinated care with plastic and/or vascular surgery. There were no significant differences in age and payor type in patients with FAFs treated with and without orthopaedic surgery. Of the patients with FAFs, 52% (n = 11) had a minimum 90-d follow-up, and 48% (n = 10) had a minimum 2-year follow-up. Two patients were readmitted within 90-d, while one patient required a reoperation within 2-years.

CONCLUSION

Over 25% of FAIs in pediatric patients result in FAFs. FAFs often present to pediatric trauma centers and the majority of these injuries occur in non-Caucasian males with government insurance. Most FAFs do not need orthopaedic surgical management; 14% of these injuries require subspecialty care by orthopaedic surgery, vascular surgery, or plastic surgery. Patients with FAFs also have lower ISS compared to patients who sustained FAIs without fracture. Thus, these patients should be treated at pediatric trauma centers with specialty care and additional research is needed to focus prevention efforts, understand reasons for poor follow-up, and evaluate outcomes after injury.

Keywords: Firearm; Fracture; Adolescent; Gunshot; Injury; Pediatric

Core Tip: Over 25% of firearm-associated injuries (FAIs) in pediatric patients result in firearm-associated fractures (FAFs). FAFs often present to pediatric trauma centers and the majority of these injuries occur in non-Caucasian males with government insurance. Most FAFs do not need orthopaedic surgical management; 14% of these injuries require subspecialty care by orthopaedic, vascular, or plastic surgery. Patients with FAFs have a lower injury severity score compared to patients who sustained FAIs without fracture. These patients should be treated at pediatric trauma centers with specialty care. Additional research is needed to focus prevention efforts, understand reasons for poor follow-up, and evaluate outcomes after injury.