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[Epidemiology of gunshot wounds at Ciudad Juárez, Chihuahua General Hospital].

BACKGROUND
Since 2007, Ciudad Juárez, Chihuahua has been considered as one of the most violent cities in the world. The General Hospital in this city is the main facility where patients with gunshot wounds are taken. The increased number of admissions of patients with these injuries to many hospitals in the country deserves special attention, as it has an impact on hospital resources and management protocols.


OBJECTIVES
To disseminate the epidemiology of fractures caused by gunshot wounds and the hospital care of these patients.


METHODS
A retrospective, observational cohort study was conducted of patients admitted to the Traumatology and Orthopedics Service, Cd. Juárez General Hospital, in Chihuahua, Mexico, from January 2008 to December 2010. All of them sustained fractures resulting from gunshot wounds.


RESULTS
A total of 1281 patients with a diagnosis of gunshot wounds were admitted to the hospital; 402 of them were included in this study with 559 fractures; 329 were males and 73 females. Of the 559 fractures, 257 involved the upper limb, 294 the lower limb, and 8 the pelvis. Gunshot wounds-related fractures were classified according to the Gustilo classification. Seventy-nine patients had grade I fractures, 302 grade III, and 21 patients had both grades. Conservative treatment was used in 44.3% of fractures and osteosynthesis in 55%. One patient underwent amputation upon admission. The most widely used osteosynthesis methods were external fixator (37%), straight plates (21%) and intramedullary nail (17%). Five patients (1.3%) underwent amputation: two with femur fracture and 3 with humeral fracture. There were 27 deep infections (6%); one of them resulted in late amputation of the pelvic limb. The most common associated injuries included: chest injuries in 20 patients and abdominal injuries in 17. The range of hospital stay was 1-18 days, with a mean stay of 11 days. The overall mortality rate considering the total number of patients admitted (1,281) was 99 patients (7.72%).


CONCLUSIONS
From 2006 to 2010 the incidence of musculo-skeletal injuries due to gunshot wounds increased 800% at the hospital. There are multiple factors and variables related with the diagnosis and treatment, many of which are not well defined and are controversial and others are well established; knowing them gives us the opportunity of improving these patients' prognosis. Treatment aimed at preserving life and the limb should be multidisciplinary. Caring for gunshot wounds warrants specialized knowledge: terminal ballistics, the affected region, the structures involved, the magnitude of the injured tissues and the biomechanics of the implants used. The two-category Gustilo classification is thought to be insufficient to classify all fractures resulting from gunshot wounds.