Gunshot Wounds and Orthopaedic Injury at a Pediatric Level I Trauma Center

Gunshot wounds (GSW) and firearm-related injuries are a leading cause of pediatric unintentional injury and death. Orthopaedic firearm injuries are also associated with higher than anticipated mortality, disproportionately affecting socioeconomically and racially disadvantaged patients. The purpose of this study was to characterize GSW injuries at our institution and to identify associated risk factors for these injuries in affected populations. A retrospective review was performed of patients aged 0-17 years who were treated for a GSW from April 2012 to October 2023 at our pediatric Level I trauma center. Orthopaedic injuries were grouped as: upper extremity fractures (clavicle, humerus, forearm, etc.), hand/wrist fractures, femur fractures, tibia/fibula fractures, foot/ankle fractures, and all others. Statistical analyses included chi-square tests to compare injury types between groups, and a linear regression model to evaluate trends in injuries over time. A total of 283 GSW patients (17.7% female, 82.3% male) were analyzed, including 158 patients (55.8%) requiring orthopaedic intervention, of which 140 sustained fractures in common extremity locations. Most patients self-identified as Black or African American (81.6%) or White (9.9%), with the remainder reporting other races (8.6%). Mean age at injury was 14.6 years. Among patients requiring orthopaedic intervention, 32.9% underwent open reduction and internal fixation and 22.9% were treated with casting or splinting with or without closed reduction. 117 patients (74.0%) were lost to follow-up. The annual number of pediatric gunshot-related injuries nearly doubled, increasing from 101 patients in 2012–2019 to 182 patients in 2020–2023. Pediatric gunshot-related orthopaedic injuries increased substantially over the study period, nearly doubling in annual volume over recent years. These injuries disproportionately affected Black or African American children and were frequently complicated by poor postoperative follow-up. Multidisciplinary, orthopaedic-centered care with close attention to at-risk patients is essential to improve follow-up and reduce long-term complications. IV (retrospective cohort) 1. Pediatric gunshot-related injuries have increased substantially in recent years, nearly doubling in volume at our institution. 2. These injuries disproportionately affected Black or African American children in our urban pediatric trauma population. 3. Multidisciplinary, orthopaedic-centered care with close attention to at-risk patients is essential to improve follow-up and reduce long-term complications.