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Gunshot wounds of the foot and lower limb

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  #1  
Old 12th April 2006, 03:34 PM
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Default Gunshot wounds of the foot and lower limb

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Hello all, I'm trying to collect non-anecdotal, verifiable information re; the above. In particular; type of weapon used, ie: calibre etc', intial presentation & first line medical response, stage at which Podiatrist involved (if anyone bothered!). Sequelae; short, medium, long term. Mangement paradigms etc. Colleagues and I in the UK are currently asembling a study which will include documented analyses of terminal ballistics in human tissue analogues ( weight bearing pigs legs, dead, and no, I wont eat the lead enhanced pork!!) replies via here (preferred 2) or podmart@tiscali.co.uk (preferred 1) or by letter; Martin Harvey, Dosthill Medical Practice, Tamworth, Staffordshire B77 2PU, United Kingdom.

Many Thanks, Martin
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Old 12th April 2006, 06:53 PM
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Martin

Many moons ago I attended a Lister Lecture at the Glasgow Royall Hospital which was given by the head of A&E at a major Belfast hospital. He gave an incredible description of the advances made in reconstructive surgery related to "knee capping", and reported the results were so good the terrorists had changed their modus operandi to shooting their victims through the foot. Rehab was less successful. I would imaging you could find useful data there. Also shooting yourself in the foot is reasonably common in the police service (US) and the freedom of information in the States should allow you to get details. If you are not familiar with search on the web ask at your library they will often provide this service at a cost.

Shooting off a toe or three is also well documented during war time (to avoid action). There is a wealth of literature on that too. Forensics and pathology text should also cover this material extensively so you might have a word with the Law Society.

Cheers
Cameron
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Old 13th April 2006, 12:48 AM
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Many thanks for the information Cameron. I first encountered a Gun wound, briefly, in a WW2 Veteran. It was on the right dorsum and presented as a cavity some 1cm deep, laterally adjacent to the navicular, which appeared to have suffered a complete fracture in the coronal plane. There was a pronounced dystrophy of that legs gastroc' and soleus, whether related I do not know. The wound, some 50 years later, was still undergoing a regular cycle, over about 8 weeks, of: semi granulation, breakdown of tissue, discharge of dark offensive exudate, re-commencement of granulation and so on. Most effective management plan seemed to have been evolved by trial and error, by the District Nurses over the years, of alternate packing with Bettadine soaked gauze, then later in the cycle inadine and strapping with PB7. As you say, WW1 produced many such, some 3,894 SIW's are recorded by the British War Office at the time, although it was a capital offence there is no record of executions actually being carried out. Favourite way to Self Inflict a called 'Blighty' wound,was, apparently, to place the forefoot under a sandbag and shoot through it, this prevented powder scorching and also reduced the velocity of the bullet so it appeared to be a spent projectile at the termination of its flight. At the time when I encountered the wound previously mentioned there was virtually no readily available source of information on the long term management of such in general practice, and there still appears to be little around, certainly in the UK. 'Battlefield' surgery accounts exist in plenty and the hotly debated question of 'does hydrostatic shock exist' - a term hated with a passion by the US Ballistician Dr Martin Fackler and esposed with equal fervour by his opponants- occupies much space in ballistic tomes. But, little appears published from a Podiatrists perspective of wound management and changes to structure and function.
Kind Regards, Martin
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Old 14th April 2006, 04:45 AM
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I saw a delightful gentleman the other day whose medical history included a gunshot to the foot. Turns out he was out rabbit shooting (a fairly common practice in rural Australia about 50 years ago - them varmints made good eatin'). He habitually rested his gun nozzle on his foot between shots, and was always very careful to have the safety on. This time he was holding the shotgun for a friend, who was less careful with the safety mechanism. The gun discharged by accident, but the gentleman in question didn't notice (among the sound of other shots and general farm mayhem). It was only when he was walking home that he felt an uncomfortable amount of fluid in his boots (which of course turned out to be blood). He noticed a hole in the toebox, removed his boot and sock, to reveal a gunshot wound between the 1st and 2nd mets. No damage to bone, and he put a bandaid on the soft tissue wound, and it healed unremarkably. He didn't bother to see a doctor.

They made farmers tough in those days! And a great story to foster the Aussie legend of Men Who Feel No Pain!

cheers,
Felicity
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Old 14th April 2006, 06:44 AM
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Smile If that dont (toe)cap it all

Thanks for a good tale Felicity :p , I must shamefacedly confess that I too rest my shotgun on my toe cap between clays. In fact a Pal of mine has a little leather fob stiched to his boot with a peg on it about 1 inch long that fits inside the shotgun muzzle when he too rests it there. He calls the device a 'happy' - dont ask me why. On a more sober note, the last collated Goverment statistics for the UK (2002 - 2003) show over 500 reported 'serious' gun woundings. This does not cover SIWs (self inflicted wounds) and non - criminal ND's (negligent discharges) or non reported incidents. Allan Green, Association of Chief Police Officers lead on Gun Crime, in a speech to Colleagues at their annual conference used the phrases;

"police attitudes to gun crime have been chaotic. Gun crime is growing in the UK like a cancer, It's coming your way, believe me."

I must stress that Im not interested in making political points, i will leave my betters to do that, but this increase in woundings means that all of us, as Podiatrists, are more and more likely to encounter the medium to long term sequelae of such wounds. As I briefly mention in a previous post, the effective management of such wounds can be challenging. It is for this reason that I and my Colleagues who are involved in this study hope we can make a small contribution to a perhaps under - explored area of our science. Once again, any information from any forum members would be most welcome, it goes without saying that such contributions would be acknowledged with thanks in any subsequent publication.

Kind Regards, Martin
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Old 11th July 2013, 01:33 PM
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Default Re: Gunshot wounds of the foot and lower limb

Gunshot injury of the foot: treatment and procedures--a role of negative pressure wound therapy.
Marinović M, Radović E, Bakota B, Mikacević M, Grzalja N, Ekl D, Cepić I.
Coll Antropol. 2013 Apr;37 Suppl 1:265-9.
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Civilian gunshot injuries of the foot are not so common in Croatia. They are related with accidents in hunting or weapon cleaning. Gunshot injuries represent a special challenge for surgeon because of specific anatomical relations and biomechanical function of the foot. We have decided to present a patient with a complex foot injury caused by hunting firearm in self-inflicted accident. A 45-year-old male presented with 12-gauge shotgun wound to his left foot. We found a complicated fracture with bone defect of 3rd, 4th and 5th metatarsals and wide soft tissue injury with skin and subcutaneous defect of the dorsal and lateral side of the foot. The wound was contaminated with numerous metal fragments, particles of rocks and ground. Surgical treatment was performed three hours after trauma and included extensive debridement of damaged soft tissue, removing of the non-viable bone and metal fragments, rocks and other foreign bodies. Negative Pressure Wound Therapy (NPWT) was applicated in the operating table. The starting therapy was continuously -125 mm Hg of vacuum. We continued with intermittent therapy of -100 mm Hg and change NPWT dressing every fourth day. After four weeks of NPWT the defect was filled with granulation tissue and split thickness skin graft was applied. Skin graft was additionally fixed with NPWT using continuous therapy at -100 mm Hg for a period of four days. Forthy days after injury there was a complete healing of all soft tissue. Control X-ray showed good bone healing process.
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Old 24th July 2015, 08:30 PM
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Default Re: Gunshot wounds of the foot and lower limb

Functional Outcomes After Gunshot Wounds to the Foot and Ankle
Zeeshan S. Husain, DPM, FACFAS, Stephen Schmid, DPM, Nicholas Lombardo, DPM
Jnl Foot Ank Surg; Article in Press
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The peer-reviewed, clinical data focusing on foot and ankle gunshot wounds are limited. The present study aimed to evaluate functional outcomes in a case series according to the area of injury, articular involvement, and the presence of infection. From January 2003 through February 2011 (8 years), 37 patients treated at Sinai-Grace Hospital (Detroit, MI) for civilian gunshot wounds localized to the foot and/or ankle were reviewed. Of these, 27 (72.97%) met the inclusion criteria. All acute wounds were thoroughly irrigated in the emergency room (8 of 27, 29.63%) or operating room (19 of 27, 70.37%) within 1 hour of presentation. The injuries were categorized as either zone 1 or 2, if localized distally or proximally to the midtarsal joint, respectively. The Maryland Foot Score was recorded and compared based on the location, articular involvement, and infection status, using analysis of variance. The mean Maryland Foot Score in patients with zone 1 injuries was 89.3 (range 72 to 100) and in patients with zone 2 injures was 61.8 (range 13 to 97; p = .001). The mean Maryland Foot Score in patients with type A injuries was 93.1 (range 72 to 100) and in patients with type B injures was 69.2 (range 13 to 99; p = .001), regardless of location. Intraoperative cultures yielded Staphylococcus epidermidis (7 of 27, 25.93%) and Enterococcus cloacae (1 of 27, 3.7%). No cases of Pseudomonas aeruginosa were found, although 9 cases (33.33%) involved shoe penetration. One third of the cases (9 of 27) yielded intra-articular pain, of which 4 (14.82%) required joint arthrodesis
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