Methods:
A retrospective review of patients presenting with GSWs to the hand at a Level 1 trauma center between 2017 and 2025. Demographic data, comorbidities, injury characteristics, and treatment modalities were collected. Univariate analyses were performed followed by multivariable logistic regression.
Results:
Among the 309 patients included, 61% were self-inflicted (n = 188) and 39% were assault-related (n = 121) injuries. For self-inflicted etiologies, 2.7% (N = 5) were intentional self-harm and 97% (N = 183) were accidental discharges (p = < 0.001).
Self-inflicted injuries were significantly associated with older age (41.4 ± 17.5 vs. 31.5 ± 12.7 years, p < 0.001), higher BMI (30.7 ± 13.8 vs. 26.9 ± 6.3, p < 0.001), hypertension (40% vs. 17%, p < 0.001), diabetes (13% vs. 5%, p = 0.017), and cardiovascular disease (11% vs. 4.1%, p = 0.029).
Assault-related injuries were more likely to involve concurrent injuries beyond the hand (57% vs. 13%, p < 0.001) and distal interphalangeal joint injuries (9.2% vs. 3.7%, p = 0.047). Self-inflicted injuries were associated with higher rates of isolated soft tissue hand injuries (23% vs. 12%, p = 0.021), tendon injuries of the hand (40% vs. 26%, p = 0.013) and digital nerve injuries (38% vs. 18%, p < 0.001). In the multivariate analysis, female patients were more likely to sustain self-inflicted hand GSWs compared to assault-related hand GSWs (p < 0.0057). Additionally, self-inflicted hand GSWs were associated with lower odds of concurrent injuries outside the hand compared to assault-related hand GSWs (p < 0.001).
Conclusions:
Self-inflicted injuries occur in older patients with more comorbidities and are more likely to have tendon and nerve injuries, whereas assault injuries are more often associated with multisystem trauma. These findings underscore the need for mechanism-specific evaluation and management strategies in hand GSWs.
