Ekstremitelerde Kemik Kırığına Neden Olan Ateşli Silah Yaralanmalarında Mermi ve Saçma Mühimmatının Hasar Sonuçlarının Karşılaştırılması
Abstract
Amaç
Ateşli silah yaralanmalarının (ASY) spektrumu geniştir ve hekimler için tanı ve tedavi açısından zorlayıcıdır. Ateşli silah yaralanmalarında kullanılan mermi ve saçma mühimmatları farklı balistik paternler sergilemekte ve vücutta oldukça farklı hasarlara neden olmaktadır. Bu çalışmanın amacı, ekstremitelerde kemik kırıklarına neden olan mermi ve saçma yaralanmalarının sonuçlarını karşılaştırmaktır.
Yöntemler
2016-2020 yılları arasında sivil Fİ nedeniyle ekstremitelerinden yaralanan ve kemik kırıkları nedeniyle ortopedi kliniği tarafından takip edilen hastaların dosyaları retrospektif olarak incelendi. Yaş, cinsiyet, yaralanan ekstremite, enfeksiyon varlığı, damar yaralanması varlığı, sinir yaralanması varlığı, toplam ameliyat sayısı, hastanede kalış süresi ve kalıcı sekeller değerlendirildi. Eksik dosyası olan olgular çalışma dışı bırakıldı. Değerlendirme kriterleri mermi ve saçma mühimmat tipleri için iki ana başlık altında karşılaştırıldı.
Bulgular
Ortalama yaşı 43.5 olan toplam 40 olgu vardı. Ortalama takip süresi 41,5 (24-61) aydı. Olguların 39'u erkek, 1'i kadındı. 28 kurşun yaralanması ve 12 saçma yaralanması vardı. Olguların 32'si alt ekstremite, 8'i üst ekstremite yaralanmasıydı. Mühimmat tipi ile ameliyat sayısı arasında anlamlı fark vardı (p=0.032) Hastanede kalış süresi saçma grubunda anlamlı olarak daha yüksekti (p=0.024, p=0.024. Genel olarak, tedaviler sonucunda %12,5 enfeksiyon, %10 damar hasarı, %17,5 sinir hasarı ve %30 kalıcı sekel meydana gelmiştir. Gruplar arasında enfeksiyon, damar hasarı, sinir hasarı ve kalıcı sekel açısından anlamlı bir fark yoktu.
Sonuç
Mermi ve saçma mühimmatının klinik sonuçları karşılaştırıldığında, yaralanmanın ciddiyeti ve tedavi sürecinde birçok farklılık vardı.
Keywords
Supporting Institution
yok
Thanks
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References
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Comparison of the Damage Results of Bullet and Pellet Ammunition in Firearm Injuries Causing Bone Fractures in the Extremities
Abstract
Purpose: The spectrum of firearm injuries (FI) is broad and challenging for physicians in terms of diagnosis and treatment. The bullets and pellet ammunition used in FI exhibit different ballistic patterns and cause quite different damage to the body. The aim of this study was to compare the outcomes of bullet and pellet injuries causing bone fractures in the extremities.
Method: The files of patients who were injured in their extremities due to civilian FI between 2016 and 2020 and who were followed up by the orthopedic clinic due to bone fractures were retrospectively analyzed. Age, gender, injured extremity, presence of infection, presence of vascular injury, presence of nerve injury, total number of operations, length of hospital stay and permanent sequelae were evaluated. Cases with missing files were excluded from the study. Evaluation criteria were compared under two main headings for bullet and pellet ammunition types.
Results: There were a total of 40 cases with a mean age of 43.5 years. The mean follow-up period was 41.5(24-61) months. 39 of the cases were male and 1 was female. There were 28 bullet injuries and 12 pellet injuries. Thirty-two of the cases were lower extremity injuries and 8 were upper extremity injuries. There were significant differences between ammunition type and number of operations (p=0.032). The length of hospital stay was significantly higher in the pellet group (p=0.024, p=0.024. Overall, 12.5% infection, 10% vascular damage, 17.5% nerve damage and 30% permanent sequelae occurred as a result of treatments. There were no significant differences between the groups in terms of infection, vascular injury, nerve injury and permanent sequelae.
Conclusion: It was concluded that pellet injuries require longer hospital stays and a higher number of surgeries compared to bullet injuries.
Keywords
References
- 1. Oymacı E, Kapkaç M, Uçar Y, Ertan H, Özdedeli E, Tokat Y. The effects of gunshot and shotgun wounds to mortality and morbidity. Turk J Trauma Emerg Surg 1997;3:132– 136.
- 2. Bartlett C.S. Clinical update: gunshot wound ballistics. Clin Orthop Relat Res. 2003;(408):28–57.
- 3. Meral O, Sağlam C, Güllüpınar B, Aktürk ÖE, Beden S, Parlak İ: Investigation of firearm injury cases presented to training and research hospital’s emergency service. Turk J Trauma Emerg Surg, 2020;26(1):74-79.
- 4. Dougherty PJ, Vaidya R, Silverton CD, Bartlett CS III, Najibi S. Joint and long-bone gunshot injuries. Instr Course Lect 2010;59:465–479.
- 5. Baumfeld D, Brito ASP, Torres MS, Prado KL, Andrade MAP, Campus TVO: Firearm-Related Fractures: Epidemiology and Infection Rate. Rev Bras Ortop 2020;55(5):625–628.
- 6. Moye-Elizalde GA, Ruiz-Martínez F, Suarez-Santamaría JJ, RuizRamírez M, Reyes-Gallardo A, Díaz-Apodaca BA. [Epidemiology of gunshot wounds at Ciudad Juárez, Chihuahua General Hospital]. Acta Ortop Mex 2013;27(04):221–235.
- 7. Fackler ML: Literature review #2. Wound Ballistics Rev 1997;3:42–43.
- 8. Özsoy S, Ketenci HÇ, Askay M: Fatal land hunting-related injuries in the Eastern Black Sea region-Turkey. Turk J Trauma Emerg Surg, 2022;28(10):1494-1499.
- 9. Nag NK, Sinha P. An investigation into pellet dispersion ballistics. Forensic Sci Int. 1992;55(2):105–130.
- 10. Baum GR, Baum JT, Hayward D, MacKay BJ. Gunshot Wounds: Ballistics, Pathology, and Treatment Recommendations, with a Focus on Retained Bullets. Orthopedic Research and Reviews 2022;14:293–317.
- 11. Gugala Z, Lindsey RW. Classification of Gunshot Injuries in Civilians. Clin Orthop Relat Res, 2003;408:65–81.
- 12. Sari A, Ozcelik IB, Bayirli D, Ayik O, Mert M, Ercin BS, Baki H, Mersa B: Management of upper extremity war injuries in the subacute period: A review of 62 cases. Injury 2020;51(11):2601–11.
- 13. Gustilo RB, Anderson JT: Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: Retrospective and prospective analyses. J Bone J Surg 1976;58A:453–458.
- 14. Glezer JA, Minard G, Croce MA, Fabian TC, Kudsk KA: Shotgun wounds to the abdomen. Am Surg. 1993;59:129- 132.
- 15. Feliciano DV, Burch JM, Patrinel VS, et al: Abdominal gunshot wounds. An urban trauma center’s experience with 300 consecutive patients. Ann. Surg. 1988;208:362-370.
- 16. Tokyay A, Özkan S, Güven N, İsmailov U, Dikici A: First Intervention in Firearm Injuries and Management of Compliations. J Contemp Med 2021;11(6):790-794
- 17. Burg A, Nachum G, Salai M, et al. Treating civilian gunshot wounds to the extremities in a level 1 trauma center: our experience and recommendations. Isr Med Assoc J. 2009;11(9):546-551.
- 18. Abghari M, Monroy A, Schubl S, Davidovitch R, Egol K. Outcomes Following Low-Energy Civilian Gunshot Wound Trauma to the Lower Extremities: Results of a Standard Protocol at an Urban Trauma Center. Iowa Orthop J. 2015;35:65-69.
- 19. Engelmann EWM, Roche S, Maqungo S, Naude D, Held M. Treating fractures in upper limb gunshot injuries: the Cape Town experience. Orthop Traumatol Surg Res 2019;105(3):517-522.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Services and Systems (Other) |
| Journal Section | Articles |
| Authors | |
| Early Pub Date | March 29, 2024 |
| Publication Date | March 31, 2024 |
| Submission Date | December 3, 2023 |
| Acceptance Date | March 6, 2024 |
| Published in Issue | Year 2024 Volume: 14 Issue: 1 |
The published articles in SMJ are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.