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American Association for Hand Surgery

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Understanding and Preventing Gun-Related Hand Injuries
William Lange, BS, Daniel L Davenport, PhD and Debra A Bourne, MD, University of Kentucky, Lexington, KY

Introduction
Gun injuries to the hand and arm cause severe pain and disability. The aims of this study are two-fold. First is to understand how gun injuries occur and what risk factors may contribute. The second aim is to better understand the severity of these injuries and resulting medical resource utilization and patient disability.

Methods & Materials
Following approval from the institutional review board, patients presenting with gun injuries to the upper extremity were prospectively enrolled from April 2020-January 2021 from a single academic center in Kentucky. A 16-question survey regarding how the injury occurred, visual analog pain scale, and the Disability of Arm, Shoulder, and Hand (DASH) Questionnaire were completed by patients during their first clinic appointment. Patient charts were reviewed to assess injury severity and treatment and return to work status. Patient characteristics were compared to the general Kentucky population.

Results
Twenty-three respondents were included. The mean age was 40 years and the majority of injuries occurred in white (87.0%) males (95.7%). Forty-eight percent of patients resided in rural communities, 39.1% were unemployed, and 60.9% had Medicaid insurance. Male gender, unemployed work status, Medicaid insurance, and rural residence were all independent risk factors for gun injury to the upper extremity (Table 1). The majority of injuries were self-inflicted (73.9%) to the non-dominant hand (69.6%) with a handgun (90.5%). Seventy-eight percent of patients reported formal gun training and 65.2% owned the injury-yielding gun. Of these owners, two-thirds had owned their gun for at least 1 year.

Nearly half of injuries occurred while storing or transporting a gun (43.5%), and the second most common activity at the time of injury was gun cleaning (17.4%) (Figure 1). The majority (87.0%) denied alcohol or substance involvement. Fifty-seven percent required surgical intervention, 34.8% had an inpatient hospital stay, and 30.4% required an amputation. Only half of employed patients returned to work (average 2.7±4.7 weeks) post-injury, and 60.0% had work limitations due to their injury upon return. Average occupational therapy discharge time was 16.7±12.5 weeks.

Conclusions
Gun injuries are largely self-inflicted and occur despite formal gun safety training.


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