Comparison of outcomes and mortality rates in lower-extremity fractures due to gunshot wounds among pediatric patients.

Objective: Treatment of extremity fractures resulting from gunshot wounds (GSWs) is difficult and takes a long time for orthopedic surgeons. In this study, we evaluated the prognosis and factors affecting mortality in lower-extremity fractures resulting from GSWs in a pediatric age group (age 0-16 years).

Materials and methods: A total of 31 patients meeting the study criteria were evaluated. Patients were classified according to the anatomical location of the injury (femur, n = 17; tibia, n = 14). The demographic characteristics of the patients, fracture classification, presence of neurological or vascular damage at the time of diagnosis, surgical procedure, follow-up period, and extremity inequality were recorded. Union time and the presence of malunion were evaluated radiologically. Finally, patients were evaluated in terms of injury severity and pain with the Mangled Extremity Severity Score (MESS) and Pediatric Trauma Score (PTS) at the time of admission, as well as the Tegner Activity Score (TAS) after recovery.

Results: No significant difference was found in the parameters examined between the anatomical location groups. In the comparisons between the patients who died in the hospital and those who survived, the mortality rate was high among patients with high MESSs and PTSs (p = 0.018, p = 0.02). The causes of death in the hospital were not due to the extremity injuries but due to additional injuries (p = 0.001).

Conclusion: No difference was found in terms of functional results, fracture types, vascular and nerve injuries, and mortality rates in terms of anatomical region. High MESSs and PTSs at admission were related to the mortality rate. Deaths were related to additional injuries and not to the extremity injuries.