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In conventional gunshot injuries to targets containing bone the resulting osseous fragments do not precede but follow the bullet on its further way through adjacent soft tissues. The term "secondary projectiles" for the particles does not appear to be appropriate since they are not believed to have enough energy necessary for creating their own wound channels away from the temporary cavity. Former studies have shown that in angled shots to glass panes the bulk of splinters does not follow the bullet's trajectory: The majority of the glass fragments, especially the larger ones, move at right angles to the pane shot through. The aim of the presented study was to examine whether osseous fragments behave like glass splinters in angled shots to flat synthetic bone. In this context, it should also be assessed, whether the bone fragments might act as secondary projectiles in rare cases. To answer these questions, test shots were fired to composite models consisting of flat synthetic bone and ballistic gelatin. Pistol cartridges 9 mm Luger were used to fire the shots which were video-documented with a high-speed camera. Afterwards, the composite models underwent CT examination and macroscopic inspection. Video-documentation revealed that the larger bone particles from the perforation site move at a roughly right angle from the osseous sheet into the gelatin, causing an eccentric bulge of the temporary cavity. The smaller bone fragments were also lodged along the bullet's path, predominantly in the cracks radiating from the permanent wound channel. [ABSTRACT FROM AUTHOR]

Electric fences are widely used in human–elephant conflict mitigation. However, elephants constantly challenge and overcome fences, which is a growing concern. We studied how elephants crossed the perimeter electric fence around the Udawalawe National Park (UWNP), Sri Lanka. Using camera traps, we monitored 18 fence posts and an open gate in the fence over 605 days from 2016 to 2019. Photographs of 3097 fence crossings were analysed to obtain demographic data for fence crossing elephants, crossing methods, and the daily and seasonal timing of fence crossing. We identified 77 adult males and 12 adult females that crossed the fence, which represent about 17% of the adult elephants in UWNP. Most of the crossings were through the open gate at night. Elephants used a variety of crossing methods, comprised of crossing at the open gate, at previously toppled posts, by crashing through wires and stepping over wires, as well as by using the trunk or forefeet to topple posts. Fence voltage was not a determinant of fence crossing. The frequency and timing of fence crossings varied between locations with later exits and less time spent outside, at crossing points bordering human dominated areas. Our results emphasis on the importance of taking into account the problem solving abilities of elephants in fence design and location, such as energising fence posts and constructing exclosure fences at the boundaries of crop fields and settlements, in employing electric fences to mitigate human‐elephant conflict. [ABSTRACT FROM AUTHOR]

Gunshot wounds (GSWs) to the vertebral column represent an important cause of morbidity and mortality in the United States, constituting approximately 20% of all spinal injuries. The management of these injuries is an understudied and controversial topic, given its heterogeneity and lack of follow-up data. To characterize the management and follow-up of GSWs to the spine. A multi-institutional retrospective review of the experience of two urban Level 1 trauma centers. Patients with GSWs to the spine between 2010–2021. Measures included work status, follow-up healthcare utilization, and pain management were collected. Charts were reviewed for demographics, injury characteristics, surgery and medical management, and follow-up. Statistical analysis included T-tests and ANOVA for comparisons of continuous variables and chi-square testing for categorical variables. All statistics were performed on SPSS v24 (IBM, Armonk, NY). A total of 271 patients were included for analysis. The average age was 28 years old, 82.7% of patients were black, 90% were male, and 76.4% had Medicare/Medicaid. The thoracic spine (35%) was most commonly injured followed by lumbar (33.9%) and cervical (25.6%). Cervical GSW was associated with higher mortality (p<.001); 8.7% of patients developed subsequent osteomyelitis/discitis, 71.3% received prophylactic antibiotics, and 56.1% of cervical GSW had a confirmed vertebral or carotid artery injury. ASIA scores at presentation were most commonly A (26.9%), D (20.7%), or E (19.6%), followed by C (7.4%) and B (6.6%). 18.8% of patients were unable to be assessed at presentation. ASIA score declined in only 2 patients, while 15.5% improved over their hospital stay. Those who improved were more likely to have ASIA B injury (p<.001). Overall, 9.2% of patients underwent spinal surgery. Of these, 33% presented as ASIA A, 21% as ASIA B, 29% as ASIA C, and 13% as ASIA D. Surgery was not associated with an improvement in ASIA score. Given the ubiquitous and heterogeneous experience with GSWs to the spine, rigorous attempts should be made to define this population and its clinical and surgical outcomes. Here, we present an analysis of 11 years of patients presenting to two large trauma centers to elucidate patterns in presentation, management, and follow-up. We highlight that GSWs to the cervical spine are most often seen in young black male patients. They were associated with high mortality and high rates of injury to vertebral arteries and that surgical intervention did not alter rates of discitis/osteomyelitis or propensity for neurologic recovery; moreover, there was no incidence of delayed spinal instability in the study population. [ABSTRACT FROM AUTHOR]

In this case, the patient sustained a gunshot injury to the thigh and underwent surgery to treat a comminuted fracture. Six weeks after discharge, the patient presented with upper-thigh pain. Doppler ultrasound showed a deep femoral artery pseudoaneurysm, confirmed with computerized tomography (CT). We used coil embolization, a newly used method worldwide in recent years, to occlude the pseudoaneurysm. This reflects the complex, unknown mechanisms that contribute to such rare findings and draws attention to cases that require more extensive studies to understand potential pathological processes, leading to better management and improved outcomes. Furthermore, this case includes figures and images that illustrate the findings both pre- and postintervention, significantly enhancing the visual appeal of the procedure. Additionally, it provides a comprehensive review of other related cases, each with detailed presentations. Finally, this case illuminates the innovative application of embolization techniques in developing nations, which has resulted in lifesaving, cost-effectiveness, and a reduction in complications compared to other techniques.

BACKGROUND: Considering the large number of limb amputations in war-related gunshot wounds, early diagnosis of terminal neuromas is important to provide appropriate limb replacement. AIM: The aim of this study was to determine the feasibility of ultrasound in evaluating peripheral nerve endings and detecting terminal neuromas in patients after limb amputation due to gunshot trauma. MATERIALS AND METHODS: A total of 71 patients (men aged 20–57 years old) underwent ultrasound examination of 179 peripheral nerves. The examination was conducted according to standard technique using the ACUSON S2000 scanner (Siemens Healthineers, Germany) with a linear transducer with a frequency of 7–17 MHz, after setting the program of musculoskeletal examination. The cause of amputation was gunshot trauma. The duration of gunshot trauma ranged from 11 to 362 days, while the period between surgical intervention and the examination ranged from 11 to 340 days. The indication for the examination was pain in the limb stumps. RESULTS: A comprehensive examination of 179 peripheral nerves revealed 149 injured endings that were subjected to further evaluation. The distribution of lesion frequency revealed that the shoulder level was the most affected area in the upper extremities, while the thigh was the most affected area in the lower extremities. Notably, lesions on the left side were more prevalent in both cases. All observed changes in the endings were classified into three distinct groups: Group 1 (60%) comprised structural changes without signs of terminal neuroma. Group 2 (25%) consisted of structural changes with terminal neuroma. Group 3 (15%) included structural changes with potential (forming) terminal neuroma. In the absence of a terminal neuroma, ultrasound findings may include thickening of the nerve ending with preserved fascicular structure, decreased echogenicity, and increased vascularization of the nerve ending in color Doppler mapping. The ultrasound findings suggestive of a potential terminal neuroma include the following: the same and the presence of a globular hypoechogenic mass emanating from the nerve ending, the absence of differentiation into fasciculi in the mass, the latter not occupying the entire cross-sectional area of the nerve ending, and the mass being avascular on color Doppler mapping. The ultrasound findings of a formed terminal neuroma include the following: a club-shaped or globular hypoechogenic mass exceeding the cross-sectional area of the nerve proximally by 2 or more times, emanating from the nerve ending; absence of differentiation into fasciculi in the formation; the formation occupying the entire cross-sectional area of the nerve ending and being avascular in color Doppler mapping. The timing of terminal neuroma formation was observed to occur on average 109.9 days (14–362) after gunshot trauma and 98.2 days (14–340) after surgical intervention. The formation of terminal neuromas was observed on average 153.3 days (31–341) after gunshot trauma and 139.5 days (14–327) after surgical intervention. CONCLUSIONS: Ultrasound examination is an effective method of detecting terminal neuromas as a potential cause of pain syndrome in amputated limbs in gunshot trauma. It is recommended that ultrasound diagnosis of terminal neuromas be performed no earlier than 31 days after surgical intervention, and that ultrasound monitoring in dynamics be conducted.

Purpose: The management of femur and tibia fractures resulting from gunshot injuries is a challenge for orthopedic surgeons. One-stage and two-stage treatments are applied according to the anatomical location and severity of the injury. In this study, the importance of injury severity and anatomical location was evaluated in the choice of treatment method and its impact on prognosis in cases of lower extremity gunshot fractures. Methods: A total of 124 patients who met the study criteria were evaluated. They were grouped separately according to the anatomical location of the injury (femur, n = 73; tibia, n = 51) and the surgical method (one-stage, n = 77; two-stage, n = 47). The demographic characteristics of the patients, fracture classification, presence of neurological or vascular damage at the time of diagnosis, anatomical location of the injury, surgical procedure, and follow-up time were recorded. The time of union and the presence of malunion were evaluated radiologically. Finally, patients were assessed clinically with the New Injury Severity Score (NISS) and leg length discrepancy (LLD) calculated through measurements made on lower extremity orthoroentgenograms. Results: The rate of vascular injury and the number of Gustilo-Anderson type IIIB and IIIC cases were significantly higher in the two-stage treatment group (p = 0.001 and p = 0.000, respectively). The infection rate was also higher in the two-stage group; therefore, time to union was significantly longer (p = 0.004 and p = 0.05, respectively). LLD was higher among patients who received two-stage treatment (p = 0.015). According to the NISS scale used in clinical assessment, better scores were obtained for the one-stage group (p = 0.002). In comparisons made according to anatomical location, no significant difference was found between femur and tibia injuries. Conclusion: Regardless of anatomical location and treatment method, injuries of higher severity such as Gustilo-Anderson type IIIB and IIIC are correlated with higher rates of complications such as vascular injury, postoperative infection, delayed union, and LLD. Furthermore, in cases of severe injuries, a two-stage approach is commonly favored. [ABSTRACT FROM AUTHOR]

Background: The war in Ukraine has led to a strategic reorientation of the German Armed Forces towards national and alliance defense. This has also raised the need for medical and surgical adaptation to scenarios of conventional warfare. In order to develop appropriate and effective concepts it is necessary to identify those war injuries that are associated with a relevant primary and secondary mortality and that can be influenced by medical measures (potentially survivable injuries). Objective: The aim of this selective literature review was to identify war injuries with high primary and secondary mortality. Methods: A selective literature review was performed in the PubMed® database with the search terms war OR combat AND injury AND mortality from 2001 to 2023. Studies including data of war injuries and associated mortality were included. Results: A total of 33 studies were included in the analysis. Severe traumatic brain injury and thoracoabdominal hemorrhage were the main contributors to primary mortality. Injuries to the trunk, neck, traumatic brain injury, and burns were associated with relevant secondary mortality. Among potentially survivable injuries, thoracoabdominal hemorrhage accounted for the largest proportion. Prehospital blood transfusions and short transport times significantly reduced war-associated mortality. Conclusion: Control of thoracoabdominal hemorrhage has the highest potential to reduce mortality in modern warfare. Besides that, treatment of traumatic brain injury, burns and neck injuries has a high relevance in reducing mortality. Hospitals of the German Armed Forces need to focus on these requirements. [ABSTRACT FROM AUTHOR]

Advancements in reconstructive surgical techniques in the head and neck area have significantly improved the aesthetic and functional reconstruction of patients. Microsurgical techniques, virtual surgical planning (VSP), CAD-CAM technology, intraoperative dynamic navigation, and advanced implantology have greatly enhanced mandible reconstruction. The authors present a case report of a 30-year-old male who suffered a severe mandibular deformity from a gunshot injury. He underwent a complex reconstruction process that involved initial soft tissue repair followed by VSP for customized titanium prosthesis implantation and dental rehabilitation. Advanced software was used to aid in precise surgical and prosthetic design, ultimately restoring the patient's mandibular structure, chin alignment, and facial harmony. This innovative approach, which demonstrates the effectiveness of integrating digital technologies with surgical precision for intricate mandibular reconstructions following trauma, has a profound impact. It provides superior functional and aesthetic results compared to conventional methods, significantly improving the patient's quality of life.

Syme's operation for gunshot injuries of the foot may be a viable alternative to transtibial amputation. Objective. To analyze the results of the use of Syme's operation in patients with gunshot injuries of the foot, to highlight the important points of surgical technique, rehabilitation and prosthetics. Methods. The results of treatment of 12 men with gunshot wounds to the foot aged 23-54 years (mean age (36.1 ± 2.7) years) who underwent Syme surgery were analyzed. All patients were military personnel at the time of injury. Clinical, instrumental and microbiological examinations were used. The severity of the injury and the prospects of reconstructive treatment were assessed by the Hannover Fracture Score (HFS-97), the anatomic defect present and the severity of static-dynamic disorders. The results were evaluated according to VAS (pain) and ALAC (prosthesis using). Results. Healing of postoperative wounds in all cases occurred without complications. The observation period was from 8 months. up to 7 years (3.5 years on average). All 10 prosthetic patients use a prosthesis: 1 -- walking on a prosthesis outside the home (ALAC IV), 5 -- independent mobility (ALAC V), 4 -- mobility does not differ from the norm (ALAC VI). In two cases (15,4 %) due to pain syndrome (7,3 and 6,8 according to VAS) prosthetics was impossible -- reamputation at the level of the leg. Conclusions. Syme's operation provides a good functional result of prosthetics in case of gunshot injuries of the foot, is a real alternative to transtibial amputation in cases with preserved hindfoot. [ABSTRACT FROM AUTHOR]

Nonobstetric vaginal or vulva trauma is an extremely rare occurrence, with an incidence of < 0.2% of traumas. CT represents the gold standard in the diagnosis of gunshot lesions due to its ability to detect and stage injuries with very high sensitivity and specificity. A standardized protocol for penetrating trauma is still under debate for the use of intravenous contrast only or also rectal and oral contrast. Herein, we report a case of gunshot vaginal trauma in a 43-year-old patient presenting with vaginal bleeding. In our case, the protocol was “patient's tailored,” the intravaginal selective use of air was administered due to symptoms (vaginal bleeding) and CT findings, this 2-step protocol increased diagnostic confidence and allow a correct and challenging diagnosis.

Purpose: The purpose of this study was to report our 5 years surgical experience and the rate of neurovascular injury following gunshot fractures of the distal humerus in a in level-1 Trauma Centre in South Africa. Methods: A retrospective case series of 25 consecutive adult gunshot injuries to the distal humerus. Demographic and injury data were extracted from clinical case notes and electronic operative records. Imaging archives were used to classify fractures according to the AO/OTA classification. Results: Twenty-five male patients, with mean age of 32-years-old, sustained gunshot injuries to the distal humerus. Eleven patients had multiple gunshots. Forty-four percent of patients underwent Computed Tomography Angiography (CTA), 20% had confirmed brachial artery injury. Limbs with vascular injury were salvaged with arterial repair and external fixation. Fractures were extra-articular in 20 cases (80%). Nineteen fractures were classified as highly comminuted. Nerve injuries occurred in 52% and were all managed expectantly. Only 32% of patients attended follow-up beyond 3 months. Conclusions: These are rare challenging injuries with high rates of neurovascular damage. This demographic of patients is poorly compliant with follow up highlighting the need for high-quality early care. Brachial artery injury should be excluded with CTA and can be managed with arterial repair and external fixation. All fractures in this series were surgically managed with conventional anatomical plate and screw fixation techniques. For nerve injury, we advocate expectant management. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

In contrast to gunshot wounds in skin and bone, the medico-legal literature pays little attention to the appearance of bullet penetration sites in abdominal organs. It was only in 1983 that Metter and Schulz published an article entitled "Morphological features of gunshot wounds in the liver and spleen." According to their observations, the organs in question showed stellate tears at the bullet penetration sites resembling skin wounds from contact shots to body regions having a bony support. The study presented simulated the real conditions by means of test shots to composite models consisting of porcine organs embedded in ballistic gelatin. The ammunition used was pistol cartridges 9 mm Luger with full metal jacket round nose bullets. The shots were video-documented with a high-speed camera in order to record the bullet's travel through the target. In addition, the composite models fired at underwent CT examinations followed by a macroscopic assessment of the organs. The study confirmed the findings of Metter and Schulz with regard to the star-like appearance of gunshot wounds in the liver and spleen. Likewise, the kidney showed radiating tears originating from the bullet path, whereas the wound track in pulmonary tissue was tube-shaped and lacked additional cracks. The varying wound patterns in parenchymatous organs can reasonably be explained as a consequence of the respective viscoelastic tissue properties. [ABSTRACT FROM AUTHOR]

Abstract Background The decade-long Syrian armed conflict killed or injured more than 11% of the Syrian population. Head and neck injuries are the most frequent cause of war-related trauma, about half of which are brain injuries. Reports about Syrian brain trauma victims were published from neighboring countries; However, none are available from Syrian hospitals. This study aims to report war-related traumatic brain injuries from the Syrian capital. Methods We conducted a retrospective cohort study between 2014 and 2017 at Damascus Hospital, the largest public hospital in Damascus, Syria. Target patients were the victims of combat-related traumatic brain injuries who arrived alive and were admitted to the neurosurgery department or to another department but followed by the neurosurgery team. The collected data included the mechanism, type, and site of injury based on imaging findings; types of invasive interventions; intensive-care unit (ICU) admissions; as well as neurological status at admission and discharge including several severity scales. Results Our sample consisted of 195 patients; Ninety-six of them were male young adults, in addition to 40 females and 61 children. Injuries were caused by shrapnel in 127 (65%) cases, and by gunshots in the rest, and most of them (91%) were penetrating. Sixty-eight patients (35%) were admitted to the ICU, and 56 (29%) underwent surgery. Neurological impairment was reported in 49 patients (25%) at discharge, and the mortality rate during hospitalization was 33%. Mortality and neurological impairment associated significantly with higher values on clinical and imaging severity scores. Conclusions This study captured the full spectrum of war-related brain injuries of civilians and armed personnel in Syria without the delay required to transport patients to neighboring countries. Although the clinical presentation of injuries at admission was not as severe as that in previous reports, the inadequate resources (i.e., ventilators and operation rooms) and the lack of previous experience with similar injuries might have resulted in the higher mortality rate. Clinical and imaging severity scales can provide a handy tool in identifying cases with low probability of survival especially with the shortage of personal and physical resources.

Key Clinical Message: Combined fractures of the femoral head and acetabulum due to hip gunshot injuries (GSI) are rare, and there is no preferred treatment option. We present a 35‐year‐old male patient who sustained a right hip GSI. Delayed THA with a two‐step sequential approach is a feasible management in this situation to manage soft tissue and decrease infection rate. At a 1‐year follow‐up visit, the pain was relieved, and the function improved significantly, and he had no complaints. [ABSTRACT FROM AUTHOR]

Background: The decade-long Syrian armed conflict killed or injured more than 11% of the Syrian population. Head and neck injuries are the most frequent cause of war-related trauma, about half of which are brain injuries. Reports about Syrian brain trauma victims were published from neighboring countries; However, none are available from Syrian hospitals. This study aims to report war-related traumatic brain injuries from the Syrian capital. Methods: We conducted a retrospective cohort study between 2014 and 2017 at Damascus Hospital, the largest public hospital in Damascus, Syria. Target patients were the victims of combat-related traumatic brain injuries who arrived alive and were admitted to the neurosurgery department or to another department but followed by the neurosurgery team. The collected data included the mechanism, type, and site of injury based on imaging findings; types of invasive interventions; intensive-care unit (ICU) admissions; as well as neurological status at admission and discharge including several severity scales. Results: Our sample consisted of 195 patients; Ninety-six of them were male young adults, in addition to 40 females and 61 children. Injuries were caused by shrapnel in 127 (65%) cases, and by gunshots in the rest, and most of them (91%) were penetrating. Sixty-eight patients (35%) were admitted to the ICU, and 56 (29%) underwent surgery. Neurological impairment was reported in 49 patients (25%) at discharge, and the mortality rate during hospitalization was 33%. Mortality and neurological impairment associated significantly with higher values on clinical and imaging severity scores. Conclusions: This study captured the full spectrum of war-related brain injuries of civilians and armed personnel in Syria without the delay required to transport patients to neighboring countries. Although the clinical presentation of injuries at admission was not as severe as that in previous reports, the inadequate resources (i.e., ventilators and operation rooms) and the lack of previous experience with similar injuries might have resulted in the higher mortality rate. Clinical and imaging severity scales can provide a handy tool in identifying cases with low probability of survival especially with the shortage of personal and physical resources. [ABSTRACT FROM AUTHOR]

Ballistic traumas among civilians are usually from low velocity, low calibre weapons such as soft air guns. The facial skeleton is an area of high aesthetic/functional value, and therefore, this is a showcase for technical description of a minimally invasive endoscopic approach for the removal of a bullet from the pterygopalatine fossae. [ABSTRACT FROM AUTHOR]

Key Clinical Message Combined fractures of the femoral head and acetabulum due to hip gunshot injuries (GSI) are rare, and there is no preferred treatment option. We present a 35‐year‐old male patient who sustained a right hip GSI. Delayed THA with a two‐step sequential approach is a feasible management in this situation to manage soft tissue and decrease infection rate. At a 1‐year follow‐up visit, the pain was relieved, and the function improved significantly, and he had no complaints.

Background: Civil war in Syria that started in 2011 has caused death and injuries of thousands of people. Head trauma is one of the most important surgical emergencies both in wartimes and out of wartimes. Materials and methods: A total of 75 patients (58 males and 17 females) who presented with head trauma due to gunshot injuries such as bullet and shrapnel during the Syrian war between 2014 and 2015 were evaluated retrospectively. Patients who had neurological and radiological examinations were included in the study. Results: Twenty (26.67%) of 75 patients admitted to our hospital due to head trauma with penetrating gunshot died. The mortality rate of patients with brain parenchymal hemorrhage was found to be significantly higher than those without (p<0.001). The mortality rate of patients with brain edema was found to be significantly higher than those without (p=0.003). In addition, the mortality rate in patients with ventricular hemorrhage and subarachnoid hemorrhage were found to be significantly higher than those without (p=0.081 for ventricular hemorrhage, p=0.056 for subarachnoid hemorrhage). Conclusion: Radiological imaging makes an important contribution to creating the necessary data in the first intervention in patients with head trauma injured by gunshot, in the decision of surgical emergency intervention if necessary, and in the management of complications. [ABSTRACT FROM AUTHOR]

Background: The objectives of this study are to: (1) describe the demographics, injury patterns, and treatment characteristics of patients who sustained a gunshot injury (GSI) of the hand; and (2) examine the utilization of healthcare resources in patients with a GSI of the hand. Methods: We retrospectively identified 148 adult patients who were treated for a GSI of the hand between January 2000 to December 2017 using multiple International Classification of Diseases Ninth and Tenth Edition (ICD-9 and ICD-10) codes. We used bivariate and multivariable analysis to identify which factors are associated with unplanned reoperation, length of hospitalization, and number of operations. Results: Multivariable logistic regression showed that fracture severity was associated with unplanned reoperation. Multivariable linear regression showed that fracture severity is associated with a higher number of hand operations after a GSI of the hand, and that a retained bullet (fragment) and patients having gunshot injuries in other regions than the hand had a longer length of hospitalization. Seventy (47%) patients had sensory or motor symptoms in the hand after their GSI, of which 22 (15%) patients had a transection of the nerve. Conclusions: Sensory and motor nerve deficits are common after a GSI of the hand. However, only 31% of patients with symptoms had a transection of the nerve. A retained bullet (fragment), having more severe hand fractures, and GSI in other regions than the hand are associated with a higher number of operation and a longer period of hospitalization. [ABSTRACT FROM AUTHOR]

Gunshot injuries are the leading cause of death among children in the United States. The goal of this study was to better understand if certain age groups, mechanisms of injury, and type of firearms were associated with the increasing rates of pediatric gun-related trauma. We hypothesized that the extremities were disproportionately targeted when compared with the random likelihood of striking specific body-surface areas. This study includes pediatric firearm-related injury (FRI) patients who presented to a single free - standing level 1 pediatric hospital or died at the scene from 2010 to 2021. The hospital data was collected prospectively as part of a level 1 trauma system electronic database. Death data was collected from the local coroner's office. Between 2010 and 2021, 1,126 pediatric FRI occurred in the geographic region studied. Demographic information available for 1,118 patients showed that 897 (80.23%) were male, and that black individuals had a statistically significant increased rate of FRI compared with white or Hispanic individuals. Mean age was 13.69 years. Most injuries were caused by handguns. This data could help leaders design strategies to combat the violence, such as legislation that limits handgun access to all, especially children, and mandates safe storage of handguns. Gun-lock programs, universal background checks, and firearm-ownership education also might help stem this tide of violence. Level II Prognosis study. • According to the CDC, firearm-related injury is now the number one cause of death among children. • All pediatric age groups are experiencing increases in firearm-related injuries, with the greatest being assaults and accidents with handguns among adolescents. Certain body regions are more affected, depending on the injury mechanism. [ABSTRACT FROM AUTHOR]

Purpose: This is a retrospective case report in which we describe our findings in two cases of endophthalmitis associated with perforating gunshot injury, in which we documented intraocular intrusion of multiple eyelashes as a plausible source of infection. Patients and Methods: Two male patients, 22 and 29 years old, respectively, presented with endophthalmitis following primary repair of rupture globe secondary to gunshot injury. Both patients had vitrectomy and silicone oil injection. Preoperative imaging and intraoperative findings confirmed the perforating nature of the projectile. Results: In both patients, we detected eyelashes that were concealed either in the pars plana region or within vitreous exudates. Silicone oil was not removed in both patients to prevent phthisis bulbi and because there was no potential for visual improvement. The postoperative course in both cases was uneventful. Conclusion: Gunshot injuries can inoculate eyelashes impregnated with infectious microorganisms into the eye. In cases presenting with endophthalmitis associated with a gunshot injury, we recommend meticulous examination of the posterior segment and the pars plana region during vitrectomy to exclude the presence of occult lashes. [ABSTRACT FROM AUTHOR]

Objective: Kilis, Turkey, a city near Aleppo, Afrin and Azez, Syria, where conflicts are intense, is one of the cities that provides initial emergency treatment. The aim in this study was to analyze the clinical and radiological characteristics of and treatment methods and results in pediatric patients admitted to Kilis State Hospital with cranial gunshot wounds obtained during the Syrian war. Materials and methods: In this study, 62 pediatric patients treated for cranial gunshot wounds obtained during the civil war in Syria between December 2011 and May 2017 at the Neurosurgery Clinic of Kilis State Hospital on the Turkish side of the Turkey-Syria border were retrospectively analyzed. Results: A total of 62 patients were evaluated. Forty-six (74.2%) patients were male and 16 (25.8%) were female. The mean age of the patients was 11.4 ± 6.3 (range: 1 month to 18 years) years. The mean Glasgow coma scale (GCS) score was 7.2 ± 3.8. Surgical treatment was performed in 36 patients (58.1%). Six (16.7%) of the surgically treated patients and 15 (57.7%) of the conservatively treated patients died (p < 0.001). While good clinical results (GOS4-5) were obtained in 24 (66.7%) patients who underwent surgical treatment, only 8 (30.8%) patients who underwent conservative treatment had good clinical results (GOS 4–5). The treatment results in patients with a GCS score of between 9 and 15 who were treated with both methods were significantly better (GOS score of 4–5) (p < 0.05) than those in patients with a GCS score of 8 or lower. The treatment results of the patients aged 10–18 years were significantly better than those of patients aged 0–9 years (GOS 4–5) (p < 0.05). Conclusion: In this study, the GCS score on admission was a significant predictive factor for survival in pediatric patients with cranial gunshot wounds. The outcomes of patients aged 0–9 years with severe neurological damage were worse than those in patients aged 10–18 years. On the basis of the analyses of the treatment methods and GCS and GOS scores of the patients in our study, we conclude that surgical treatment should be performed immediately in all patients with radiological indications and a GCS score higher than 3. Additionally, we conclude that child soldiers exist in Syria. [ABSTRACT FROM AUTHOR]

Conducted electrical weapons (CEW) have risks including trauma associated with uncontrolled falls, probes penetrating the eye, and fume ignition. A lesser-known risk is weapon-confusion error with officers mistakenly discharging their firearm when they intended to deploy their electrical weapon. We searched for incidents of possible weapon confusion with the TASER® brand CEWs via open-source media, litigation filings, and a survey of CEW law enforcement master instructors. We found 19 incidents of possible CEW weapon confusion in law enforcement field uses from January 2001 to April 2021. We eliminated a case as not meeting our criteria for probable weapons confusion leaving 18 cases, thus giving a demonstrated CEW discharge risk of 3.9 per million with confidence limits (2.4–6.2 per million) by Wilson score interval. Ipsilateral carry of the weapons was historically correlated with increased risk vs. contralateral carry. Officer gender was not a predictor of weapon confusion. The psychological issues behind weapon confusion under stress are discussed. The concurrent carry of electrical weapons and firearms presents a very small but real risk of injury and death from confusion between an electrical weapon and a firearm. [ABSTRACT FROM AUTHOR]

In this case, the patient sustained a gunshot injury to the thigh and underwent surgery to treat a comminuted fracture. Six weeks after discharge, the patient presented with upper-thigh pain. Doppler ultrasound showed a deep femoral artery pseudoaneurysm, confirmed with computerized tomography (CT). We used coil embolization, a newly used method worldwide in recent years, to occlude the pseudoaneurysm. This reflects the complex, unknown mechanisms that contribute to such rare findings and draws attention to cases that require more extensive studies to understand potential pathological processes, leading to better management and improved outcomes. Furthermore, this case includes figures and images that illustrate the findings both pre- and postintervention, significantly enhancing the visual appeal of the procedure. Additionally, it provides a comprehensive review of other related cases, each with detailed presentations. Finally, this case illuminates the innovative application of embolization techniques in developing nations, which has resulted in lifesaving, cost-effectiveness, and a reduction in complications compared to other techniques., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Gunshot injuries to the foot with segmental bone defects can be challenging to treat. When the vascularity is intact and the soft tissues allows, the goal should be to reconstruct the bony defect. We present 2 cases of a gunshot injury to the foot with a defect of the first metatarsal bone. Both cases were treated, with favorable outcome, with a structural iliac crest graft, internal fixation, and bone morphogenic protein 2. Level of Evidence: V, cases series, technical., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background/Aim: Gunshot injury-related mandibular fractures often have a complex pattern, characterized by comminution, bone loss, and soft-tissue avulsion. The management is difficult and varies between individual cases.

Missile embolism as a consequence of gunshot wounds is a rare occurrence, and can lead to severe complications such as endocarditis, pulmonary thromboembolism and arrythmias. The correct diagnosis of bullet embolism can be challenging in an emergency care setting, often requiring a combination of clinical, radiological and surgical resources. The management of a venous missile embolism depends on characteristics such as size and location of the projectile, and must be highly individualized for each patient. In this report, a case of bullet embolism to the heart in a patient who suffered a gunshot wound to the left subclavian vein provides a backdrop for the discussion of the diagnosis and treatment of this rare ballistic injury.

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.

Bullet embolism of pulmonary artery is a vascular traumatic entity that is a very rare but with serious complications. The bullet can lead to vascular embolism by entering directly into the intravascular area or by migration. In pulmonary artery bullet embolism, complications with high mortality such as thrombosis, sepsis, endocarditis, cerebral stroke may be encountered. Observation and follow-up are sufficient in asymptomatic venous bullet embolism cases. In this case report, we aimed to share our experience with a patient who developed a bullet embolism of pulmonary artery as a result of gunshot injury from the right iliac region.

Background and Aim: The injuries due to gunshot can form extensive defects. The management of these defects is required in multistage procedures, and the treatment achievement should be evaluated in many aspects. In this study, a methodology was tried to be developed to reveal the path to be followed in the management of maxillofacial defects caused by high-energy close-range gunshot injury. In addition, similar cases were analyzed retrospectively, and the functional and social successes of the treatment were evaluated. Subjects and Methods: Five patients with high-energy gunshot injuries were retrospectively analyzed. The tissue requirements of the patients were identified. The technical and quantitative details of the treatment were recorded. The facial disability index was used to evaluate the patient's social and motor functions in the 1st year after the operations were completed. Results: The patients' mean age was 31 (17–45), and all of them were male. The mean follow-up time was 25 months (14–26), and the mean operation amount was 7.6 (3–11). Four mandibular, one maxillary, and five soft-tissue defects were detected. It was detected that these defects were managed in basic four steps. Satisfactory, functional, and social results were obtained in four patients in the postoperative 1 year. Conclusions: The management of this group of patients comprises complicated procedures. First, the patient should be stabilized vitally. Definitive reconstruction should be carried out after the wound is stabilized. To increase treatment success, the patient's mental status should be stabilized during the treatment period. Providing social function is important along with physical function.

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.

Rationale: Maxillofacial gunshot injury leads to significant soft tissue and bone defects, which compromise airway patency, thus posing a challenge for the anaesthesiologist. The utility of the videolaryngoscopy-assisted fibreoptic intubation (VAFI) technique in maxillofacial gunshot injury has not yet been described in the literature. Patient Concerns: We report the case of a young male presenting with extensive maxillofacial wounds with fractures of the bilateral maxilla, mandible and floor of orbit secondary to self-inflicted gunshot injury. Diagnosis: Major peri-operative concerns included anticipated difficult airway, control of potential haemorrhage and airway oedema. Treatment: A flexible fibreoptic bronchoscope used in combination with a video laryngoscope was used to successfully secure the airway. Outcome: He was extubated on the same day and discharged after two weeks. Take-Away Lessons: The current case highlights the safe and effective use of the videolaryngoscopy-assisted fibreoptic intubation technique in maxillofacial gunshot injury. [ABSTRACT FROM AUTHOR]

Craniocerebral gunshot injuries (CGIs) are highly fatal and mostly seen in the military settings. CGIs to the posterior cortical regions and cerebellum in civilian population are uncommon. Cerebellum once thought to be mediating the motor and vestibular functions is increasingly seen as an important structure for human cognition and affect. We present a case of a 53-year-old police inspector who sustained a gunshot injury in the suboccipital region with resulting damage to predominantly left cerebellum and right occipital lobe. Patient presented with complaints of neck pain, reduced clarity of speech, and mild forgetfulness for day-to-day affairs after 7 months of injury. A comprehensive neuropsychological assessment revealed impairments in motor speed, processing speed, sustained attention, executive functions (verbal fluency, working memory), and encoding component of memory functions. The speech-language assessment revealed mild dysarthria and mild word finding difficulties. His profile with mild to moderate deficits in neuropsychological and speech language functioning was partly congruent with the cerebellar cognitive affective syndrome or Schmahmann's syndrome. The spontaneous recovery and extent of damage to cerebellum may explain the milder form of the syndrome. The case highlights the need to routinely screen for cognitive-affective disturbances in patients with traumatic lesions to cerebellum. [ABSTRACT FROM AUTHOR]

Urethral injuries are infrequent, and management is challenging. We present a case of urethral transection associated with a penile fracture following gunshot injury. During the initial exploration complete urethral transection revealed with a bleeding penile fracture. With the use of an antegrade guidewire and a catheter, urethral ends aligned, and penile fracture repaired with suturing the tunica albuginea. Post-surgery urethrogram revealed stricture formation at bulbar urethra and detail of a gunshot injury was disclosed. Delayed stricture excision and end-to-end anastomosis was achieved, resulting in satisfactory urethral and penile functions.

Study Design: This study was a multicenter retrospective analysis of cervical spine gunshot wound (GSW) patients., Objective: The present study was conducted to evaluate the management and outcomes of vascular injuries following GSW involving the cervical spine., Summary of Background Data: Gunshot wounds (GSW) injuring the cervical spine are associated with high rates of vascular injury., Methods: Charts of patients with GSW involving the cervical spine at two Level 1 trauma centers were reviewed from 2010 to 2021 for demographics, injury characteristics, management and follow-up. Statistical analysis included T tests and ANOVA for comparisons of continuous variables and chi-square testing for categorical variables, non-parametric tests were used when indicated. Beta-binomial models were used to estimate the probabilities outcomes. Bayesian regression models were utilized to compute risk ratios (RR) and their 95 % confidence intervals (CI) to enhance the inferential robustness., Results: 40 patients with cervical spine GSW and associated cerebrovascular injury were included in our analysis. 15 % of patients had Biffl grade (BG) V injuries, 50 % grade IV, and 35 % grade III-I. Angiography was performed in 35 % of patients. 5 of these patients (BG V-III) required endovascular treatment for pseudoaneurysm obliteration or parent vessel sacrifice. 7 patients (22 %) showed evidence of progression. 70 % of patients were placed on antiplatelet therapy for stroke prevention. Bayesian regression models with a skeptical prior for cerebral ischemia revealed a mean RR of 4.82 (95 % CI 1.02-14.48) in the BG V group, 0.75 (95 % CI 0.13-2.26) in the BG IV group, and 0.61 (95 % CI 0.06-2.01) in the combined BG III-I group. For demise the mean RR was 3.41 (95 % CI 0.58-10.65) in the BG V group and 1.69 (95 % CI 0.29-5.97) in the BG IV group. In the high BG (V, IV) group, 54.55 % of patients treated with antiplatelet therapy had complications. None of the patients that were treated with antiplatelet therapy in the low BG (III-I) group had complications., Conclusions: Cervical spine GSWs are associated with high-grade vascular injuries and may require early endovascular intervention. Additionally, a high rate of injury progression was seen on follow up imaging, requiring subsequent intervention. Reintervention and demise were common and observed in high BG (V, IV) groups. The incidence of stroke was low, especially in low BG (I-III) groups, suggesting that daily aspirin prophylaxis is adequate for long-term stroke prevention., Competing Interests: Conflicts of Interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The war in Ukraine has led to a strategic reorientation of the German Armed Forces towards national and alliance defense. This has also raised the need for medical and surgical adaptation to scenarios of conventional warfare. In order to develop appropriate and effective concepts it is necessary to identify those war injuries that are associated with a relevant primary and secondary mortality and that can be influenced by medical measures (potentially survivable injuries)., Objective: The aim of this selective literature review was to identify war injuries with high primary and secondary mortality., Methods: A selective literature review was performed in the PubMed® database with the search terms war OR combat AND injury AND mortality from 2001 to 2023. Studies including data of war injuries and associated mortality were included., Results: A total of 33 studies were included in the analysis. Severe traumatic brain injury and thoracoabdominal hemorrhage were the main contributors to primary mortality. Injuries to the trunk, neck, traumatic brain injury, and burns were associated with relevant secondary mortality. Among potentially survivable injuries, thoracoabdominal hemorrhage accounted for the largest proportion. Prehospital blood transfusions and short transport times significantly reduced war-associated mortality., Conclusion: Control of thoracoabdominal hemorrhage has the highest potential to reduce mortality in modern warfare. Besides that, treatment of traumatic brain injury, burns and neck injuries has a high relevance in reducing mortality. Hospitals of the German Armed Forces need to focus on these requirements., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Purpose: Risks of handheld electrical weapons include head impact trauma associated with uncontrolled falls, ocular probe penetration injuries, thermal injuries from the ignition of volatile fumes, and weapon confusion police-involved shooting. There is also an uncommon but critical risk of a shooting after a subject gained control of an officer's electrical weapons. Methods: The authors searched for police shooting incidents involving loss of control of TASER® weapons via open-source media reports, crowd-sourced internet sites, litigation filings, and a survey of Axon law-enforcement master instructors. Results: The authors report 131 incidents of subjects attempting to or gaining control of an officer's electrical weapon from 2004 to 2020, 53 of which resulting in a shooting. These incidents demonstrated a risk of 11.8 shootings per million electrical weapon discharges (95% confidence limits of 9.0 to 15.1 per million by Wilson score interval). Conclusions: The use of electrical weapons presents a rare but real risk of injury and death from a shooting following a subject's attempts to gain control of the weapon. [ABSTRACT FROM AUTHOR]

Gunshot injury remains relevant at the present time and requires serious study. During the examination of a gunshot injury, it is necessary to answer the investigator's questions about the cause of death, the type and rate of thanatogenesis, the distance of the shot, the sequence and mechanism of damage formation, and the severity of the injury. The aim of the study was to determine the type of thanatogenesis in death from various types of gunshot injuries. Standard methods of sectional research, forensic histological methods, morphological and statistical analysis, supplemented with semi-quantitative technologies of thanatogenetic analysis were used in the study. The material for this study was 85 cases of death from gunshot injuries, which was distributed by gender, age, location of the injury, type and rate of thanatogenesis, type of gunshot injury (bullet and shotgun wounds), the distance of the shot and the duration of hospital stay. [ABSTRACT FROM AUTHOR]

The use of Proprioceptive Neuromuscular Facilitation (PNF), namely relaxation techniques, rhythmic initiation, a combination of isotonics, stabilizing and dynamic reversing, rhythmic stabilization and motor patterns, allows to improve motor function and to achieve active participations of patients with musculoskeletal injuries in the process. Therefore, the purpose of the study was to evaluate the effect of proprioceptive neuro-muscle facilitation techniques on index goniometry in individuals with gunshot lesions of the proximal humerus. The study involved 56 middle-aged men, who were randomized to two levels by group size. Investigation group (n=28) received proprioceptive neuromuscular facilitation, control group (n=28) received standard kinesiotherapy program and massage. Goniometry was performed on all participants for physical therapy on 28, 56 and 84 days of the treatment. Limits of movement amplitude were fixed in all three planes, which respond to the nature of the arthrogenic contracture. The total dynamics of increase in the amplitude of active movements in the shoulder complex in participants under the influence of proprioceptive neuromuscular facilitation, noted higher (p=0.038; t=6.94) than in control group which underwent kinesiotherapy and massage. Therefore, positive changes were observed under the influence of PNF in the active amplitude of movement in men with gunshot lesions of the proximal humerus; this in turn allowed to break the circle of pain and improve the functionality of the upper extremity. [ABSTRACT FROM AUTHOR]

Common peroneal nerve injuries represent the most common nerve lesions of the lower limbs. Peroneal palsy might be due to traumatic origin. However, bilateral peroneal nerve involvement in an injury is rarely seen in clinical practice. Here, the first case report of a bilateral peroneal nerve paralysis after gunshot injury is presented.

Gunshot injuries can cause damage to the tissues due to mechanical or blast effects from bullets. In this type of injury in the pelvic area, a careful rectal examination is mandatory, and the patient may require a protective stoma in the presence of rectal injury. Rectal damage can be detected using laparoscopic and endoscopic techniques, resulting in lower morbidity and mortality. We here report a patient having rectum injury due to blast effect which resolved spontaneously without surgical intervention. [ABSTRACT FROM AUTHOR]

Background: Extremity gunshot injuries are a common cause of morbidity and mortality in our environment. They pose a management challenge because of the complex soft tissue and bony injuries. Objectives: The objectives of this study was to determine the pattern and treatment outcomes of these injuries in our setting. Materials and Methods: This was a prospective study of extremity gunshot injuries treated at National Orthopaedic Hospital, Enugu, Nigeria over a 12-month period. Results: Fifty-five patients were studied, with a mean age of 36.9 ± 13.39 years and a male-to-female ratio of 8.2:1. The two top causes of gunshot injuries were armed robbery (41; 74.5%) and assaults/communal clash (6; 10.9%), and the most common type of gun was the rifle (21; 38.2%). Gunshot fracture was the commonest type of injury among the patients (39, 70.9%). Only 34.5.1% of our patients presented to hospital within the first 6h. Secondary wound closure was the commonest method of wound cover. Majority of the gunshot fractures were treated non-operatively. The duration of hospitalization ranged from 2 days to 13 weeks with a mean duration of 4.9 weeks. Late presentation, presence of fracture, and wound infection were associated with prolonged hospital stay. Outcome of treatment was good in 80% of patients and the mortality rate was 1.8%. Conclusion: The young adult males are more involved in extremity gunshot injuries. The fracture rate of these injuries is high with associated increased morbidity. Effective control measures aimed at reducing the incidence of gunshot injuries will reduce the negative socioeconomic impact of these injuries.

Abstract Background Projectile foreign bodies are known to cause chronic heavy metal toxicity due to the release of metal into the bloodstream. However, the local effect around the metallic object has not been investigated and the main goal of our study is to examine the influence of the object in close proximity of the object. Case presentation A 36-year-old Caucasian woman with one metallic pellet close to her sciatic nerve due to a previous shotgun injury at the gluteal area presented with a diagnosis of recurrent lumbar disk herniation at L4–5 level. A physical examination confirmed chronic neuropathy and she underwent a two-stage surgery. The surgery included removal of the foreign body, followed by discectomy and fusion at the involved level. During the removal of the metallic foreign body, a tissue sample around the pellet and another tissue sample from a remote area were obtained. The samples were analyzed by scanning acoustic microscopy, scanning electron microscopy, and energy-dispersive X-ray spectroscopy. Lead, chromium, copper, cadmium, iron, manganese, selenium, and zinc elements in tissue, blood, and serum specimens were detected by inductively coupled plasma optical emission spectroscopy. Conclusions An acoustic impedance map of the tissue closer to the metallic body showed higher values indicating further accumulation of elements. Energy-dispersive X-ray spectroscopy results confirmed scanning acoustic microscopy results by measuring a higher concentration of elements closer to the metallic body. Scanning electron microscopy images showed that original structure was not disturbed far away; however, deformation of the structure existed in the tissue closer to the foreign body. Element analysis showed that element levels within blood and serum were more or less within acceptable ranges; on the other hand, element levels within the tissues showed pronounced differences indicating primarily lead intoxication in the proximity of the metallic body. We can state that residues of metallic foreign bodies of gunshot injuries cause chronic metal infiltration to the surrounding tissue and induce significant damage to nearby neural elements; this is supported by the results of scanning acoustic microscopy, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and inductively coupled plasma optical emission spectroscopy.

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. [ABSTRACT FROM AUTHOR]

Background and Aim: The injuries due to gunshot can form extensive defects. The management of these defects is required in multistage procedures, and the treatment achievement should be evaluated in many aspects. In this study, a methodology was tried to be developed to reveal the path to be followed in the management of maxillofacial defects caused by high-energy close-range gunshot injury. In addition, similar cases were analyzed retrospectively, and the functional and social successes of the treatment were evaluated. Subjects and Methods: Five patients with high-energy gunshot injuries were retrospectively analyzed. The tissue requirements of the patients were identified. The technical and quantitative details of the treatment were recorded. The facial disability index was used to evaluate the patient's social and motor functions in the 1st year after the operations were completed. Results: The patients' mean age was 31 (17-45), and all of them were male. The mean follow-up time was 25 months (14-26), and the mean operation amount was 7.6 (3-11). Four mandibular, one maxillary, and five soft-tissue defects were detected. It was detected that these defects were managed in basic four steps. Satisfactory, functional, and social results were obtained in four patients in the postoperative 1 year. Conclusions: The management of this group of patients comprises complicated procedures. First, the patient should be stabilized vitally. Definitive reconstruction should be carried out after the wound is stabilized. To increase treatment success, the patient's mental status should be stabilized during the treatment period. Providing social function is important along with physical function. [ABSTRACT FROM AUTHOR]

Abdominal gunshot wounds have become a major problem globally, and it is commonly associated with liver injury. The aim of this study is to review our experience and outcomes of operative management of gunshot liver injures. A case series analysis reviewed all patients who underwent emergency laparotomy following liver gunshot injuries from January 1, 2011, to December 31, 2016. The collected data included age, gender, vital signs on admission, blood transfusion, grade of liver injury, associated intra-abdominal injuries, surgical procedures performed and re-operations, morbidity, and mortality rate. During the study period, we have done 71 operations for gunshot liver injured patients. The mean age was 28.5 years. There were 68 men and three women. There were 56 patients who had multi-organ injuries, while 64 patients were in shock. Liver injury grade I was occurred in two patients, while grades II, III, IV, and V have occurred in 10, 34, 19, and 6 patients, respectively. Liver tissue hemostasis was done in seven patients, 25 underwent liver tissue primary repair, 15 had direct blood vessel ligation, 21 were treated with perihepatic packing as part of damage control surgery, and three patients had a non-anatomical liver resection. Postoperative liver-related complications occurred in 15 patients, bleeding occurred in nine patients, the biliary leak in five, and hepatic abscess with septicemia in one patient. Despite the acceptance of selective non-operative management like hepatic angioembolization with its high success rate, expeditious exploratory laparotomy still has an effective role in the treatment of gunshot wounds of the liver with advanced grade penetrating injuries with acceptable morbidity and mortality. [ABSTRACT FROM AUTHOR]

Introduction: Cases of gunshot injuries among trauma patients admitted in the emergency room are fatal cases in Turkey as much as all over the world. It is perhaps the most complex group among trauma patients. Because the route of the bullet fragment, how much damage it causes on its way and which organ or organs will be harmed cannot be understood immediately so long-term follow-up may be required. Case report: A 48-year-old civilian male patient brought to our hospital after gunshot injury. It was found that he was injured with pellets in many parts of his body. He was not operated on to prevent possible bleeding and to remove the pellets. Instead, vital signs were followed. Results and Conclusion: Most of the patients who are injured by guns die. The most important reason for this is acute and large amount of bleeding. In this article, we will present a patient who has been exposed to multiple pellet shots but survived. [ABSTRACT FROM AUTHOR]