Highway Armed Robbery: A Major Cause Of Extremity Gunshot Injury In Northeastern, Nigeria

摘要

Background: Gunshot injury is a global problem and has its toll especially in a developing region like ours where poverty and violent crimes are the twin evils. Previous studies from this sub-region dwelt on abdominal and facial gunshot injuries. We retrospectively studied extremities gunshot injuries and its peculiarities in this sub-region. Methods: All case notes of patients admitted and managed at the University of Maiduguri Teaching Hospital with extremities gunshot injuries between 2001 and 2004 were retrospectively studied. Results: A total of 70 patients were studied males were affected more than females in the ration of 10.6:1. Young adults between the ages of 21 – 40 years constituted the majority with a mean of 32.2±11.2 years. Majority of the victims were traders (24.3%). The commonest reason of gunshot injury was armed robbery (80%) mostly on the highway, while accidental discharge ranked second (10%). The lower limb was the predominant site of injury (51%) with thigh accounting for (31.4%) of the injuries, majority of the fractures (90.6%) were managed by non operative methods. Wound infection (20%) was the commonest complications encountered. Conclusion: Firearms violence is a public health problem in North-eastern Nigeria. The law enforcement agencies should device strategies to monitor the sale, acquisition and use of such firearms. The government must take urgent and adequate steps to combat highway robbery in an attempt to reduce further poverty and the number of disabled people in our society. Introduction Gunshot injuries (GSI) have increasingly become more common in civilian sector, 1,2,3 making many of our trauma units resemble military hospitals. The issue is fast becoming an epidemic, which is being blamed on the dwindling economic fortunes of majority and the widening gap between the effluence and the poor in our society 4,5,6,7 leading to violent crimes especially armed robbery. Firearm injuries are potentially devastating to tissues, depending on the caliber of the weapon. In high velocity rifle and shotgun wounds, the damage to soft tissues and bone is massive with extensive tissue necrosis, such that the injury is managed similar to battle wounds5. On the other hand, low velocity pistol or handgun wounds which is the expected encounter in civilian practice, injuries are usually devoid of temporary cavitatory effects and severe soft tissue devitatilization4. The practice of early internal fixation of fracture for improved outcome and reduced period of hospitazation is still far from being realized in most developing countries4, 9 due to lack of appropriate facilities. The study is a review of extremity GSI cases presented to our hospital with a view to highlight the pattern and factors responsible for the upsurge this problem. Patients And Methods A retrospective study of patients with extremities GSI who presented to our centre between January 2001 and December 2004 was carried out. The University of Maiduguri Teaching Hospital is the level 1 tertiary health institution in the Northeast sub-region. The study area includes the six states in the Northeastern Nigeria.Source of information were patient's folder from medical records department and operating register. Data collated include age, sex, occupation and circumstance around GSI, part(s) of limb involved, associated injuries, time of presentation, modalities of treatment, duration of hospitalization, complications and out come of treatment. Data were then analysed and results presented in tabular form. Results There were seventy patients with GSI, sixty-four males and six females giving a male: female ratio of 10.6: 1. The ages of the patients raged between 12 and 60 years, with the mean of 32.2±11.2 years and majority 53 (75.7%) of the patients were aged 21 – 40 years (Table 1). Children below the age of 10 years and females above the age of 30 years were not involved in the GSI.