18 Eur J Forensic Sci ● 2016 ● Vol 3 ● Issue 3 European Journal of Forensic Sciences DOI: 10.5455/ejfs.200802 www.ejfs.co.uk Introduction Firearm injuries are a significant health burden and often involve the musculoskeletal system. Orthopedic surgeons are frequently involved in the care of fractures associated with firearms. There are many studies regarding firearm injuries; yet, few address fracture patterns. Only one study [1] uses a national database, the National Trauma Databank, but this involves only major trauma hospitals and does not capture the lesser involved injuries that visit smaller emergency departments (EDs) nor does it access the Pediatric Trauma Database. It was the purpose of this study to use a large national database which includes all ages of patients and all sizes of EDs to characterize fracture patterns associated with firearm use involving the spine and extremities. We specifically wished to analyze for differences by type of firearm and if the patient had been shot or injured in a different manner as well as disposition from the hospital. Knowledge of such data can be used as a standard reference for future studies of fractures associated with firearm use. Materials and Methods The data for this study were obtained from the Inter-University Consortium for Political and Social Research Firearm Injury Surveillance Study 1993-2008 (ICPSR 30543) [2] collected by the National Electronic Injury Surveillance System (NEISS). This database, appropriate codebooks, and other support documents are in the public domain and can be found at the ICPSR website www.icpsr.umich.edu. Detailed data for ED visits 1993 through 2008 due to firearms were downloaded from the ICPSR website. When discussing firearm injuries it is a common assumption that the patient was shot; however that is not necessarily true, as the injury could have occurred by a different mechanism (e.g. a clavicle fracture during recoil from a rifle, beaten with a handgun, etc.). We thus analyzed those patients who sustained fractures by anatomic location of the fracture and if the patient was shot or not shot. Anatomic location of the injury was grouped into the spine, upper, and lower extremity. Detailed analyses were also performed within the spine and upper and lower extremity groups. Spine and extremity fractures associated with frearms: Diferences by frearm type and injury circumstances Randall T. Loder, Neil Farren Original Research 1 Department of Orthopaedic Surgery, Riley Children’s Hospital, Indianapolis, Indiana, USA, 2 Student Affairs Office, School of Medicine, University of Indiana, Indianapolis, Indiana, USA Address for correspondence: Address for correspondence: Randall T. Loder, Department of Orthopaedic Surgery, Riley Children’s Hospital, Indianapolis, Indiana, USA. E-mail: rloder@iupui.edu Received: Received: September 10, 2015 Accepted: Accepted: December 02, 2015 Published: Published: January 15, 2016 ABSTRACT Objectives: Firearm injuries often involve the musculoskeletal system. Few studies address fracture patterns, and none use a comprehensive national database. It was our purpose to describe fracture patterns associated with firearm use involving the spine and extremities using a comprehensive database, specifically analyzing for differences by firearm type and if the patient had been shot or injured in a different manner. Materials and Methods: A retrospective analysis of prospective data collected by the National Electronic Injury Surveillance System (Firearm Injury Surveillance Study 1993-2008) was performed. The data were analyzed for the anatomic location of the fracture and if the patient was shot or not shot. Statistical analyses were performed with SUDAAN 10™ software. Results: There were an estimated 1,841,269 patients with firearm injuries; 102,931 had fractures at an average age of 27.7 years. The proportion of fractures increased from 1993 to 2008. Of the fractures, 1,981 (1.9%) involved the spine, 48,625 (47.2%) the upper extremity, and 52,325 (50.8%) the lower extremity. Spine fractures were associated only with handguns or rifles; BB guns had a high incidence of upper extremity fractures (78.6%) while fractures from other firearms were relatively equal between the upper and lower extremity. Upper extremity fractures were much more common in those who were not shot (69.7%) compared to those shot (44.4%). Conclusions: The proportion of fractures due to firearms is increasing and is the most common in the extremities. Upper extremity fractures were more likely when a BB gun was involved while lower extremity fractures were more likely when handguns/shotguns/ rifles were involved. This baseline nationwide data can be used as a reference for future studies of fractures associated with firearm use. KEY WORDS: Forensic sciences, forensic medicine, crime, firearm, fracture, lower extremity, spine, upper extremity