Patterns and Early Outcomes of Firearm-related Musculoskeletal Injuries in Patients Presenting at Kenyatta National Hospital

Abstract

Background: The incidence of firearm injuries is increasing throughout the world and Kenya is no exception. Circumstances of firearm injuries include armed robbery, police encounter, political violence and cattle rustling. Patients are usually managed with antibiotics, debridement, and external fixation acutely and definitively by open reduction and internal fixation. The most common complications of such injuries are infections and delayed union. Objectives: To determine the patterns and early outcomes of firearm-related musculoskeletal injuries in patients presenting at Kenyatta National Hospital. Study design: Cross-sectional study. Study setting: This study was carried out in Kenyatta National Hospital Accident and Emergency department, operating theatres, Orthopaedic wards, Orthopaedic clinic and the General Surgical wards. Methodology: This was a cross-sectional study done for a period of six months between April and September, 2018. Fifty six patients of all age groups with firearm injuries were recruited after obtaining informed consent. Patients’ bio-data information was obtained, history taken and physical examination performed. The injuries were examined and classified using the Gustilo-Anderson classification. Patients were started on tetanus prophylaxis and antibiotics then managed either non-operatively or operatively with debridement and or external fixation in operating theatre. After initial management on the second day and the second week, patients’ wounds were re-examined to asses for the presence or absence of infection. On the third month plain radiographs were obtained from patients with fractures to asses for delayed union. All information obtained was recorded in the questionnaire. Data analysis: Qualitative and quantitative data were collected from respondents using a questionairre. The raw data were recorded in excel sheet then transferred for analysis using SPSS version 23. For categorical factors, comparisons were done using Chi square tests. Conversely, for continuous independent variables comparison of means was conducted using Student’s t-test between the group experiencing early outcomes and those not experiencing the outcomes. Data was presented in form of tables, charts and graphs for better understanding and inferences deduced.

Results: In this study, armed robbery was the most common circumstance leading to firearm injury (52%) followed by police encounter (25%). Young people aged between 21 and 30 years (48.2%) and particularly males (89.3%) were injured due to firearms. Most of the injuries occurred in Nairobi County (69.4%), mainly in low socioeconomic regions such as Embakasi and Dagoretti. This study also found that most patients sustained firearm injuries between 6 p.m and midnight (60.7%). The common fractured bones were femur (33.3%) and ulna (23.3%). Most patients were managed operatively (92.9%). Infection rates were 12.5 % and 32.2% on the second day and second week respectively. At three months follow-up 16.7% of patients with fractures had delayed union. Conclusions: Young males are mostly affected and the most common circumstances leading to firearm injuries were armed robbery and police encounter. Patients were mostly managed operatively. Infections and delayed union are some of the complications due to firearm injuries. Recommendations: Kenyatta national hospital should have protocols for management of firearm injured patients in order to reduce morbidity and mortality.