Hip firearm injuries are rare injuries that could lead to serious complications, such as posttraumatic hip arthritis and coloarticular fistula. We report a case of a 25-year-old male who sustained a pelvic injury caused by a single bullet which led to a bilateral acetabular fracture, concomitant with a colon injury treated on an emergency basis by a diverting colostomy; acetabular fractures were treated conservatively by traction. After the patient recovered from the abdominal injury, he was presented with bilateral hip pain and limited motion; plain radiographs showed bilateral hip arthritis with proximal migration of the femoral head and bilateral acetabular defect classified as Paprosky type ⅢA. Reconstruction of the hips was performed using the same technique: impaction bone grafting for acetabular defect reconstruction and a reversed hybrid total hip arthroplasty (THA) 6 months apart. The patient presented with loosening of the left THA acetabular cup 3 years later, which was revised; then he presented with a discharging sinus from the left THA with suspicion of coloarticular fistula, which was confirmed using CT with contrast material. A temporary colostomy and fistula excision were performed, and a cement spacer was applied to the hip. After clearing the infection, a final revision THA for the left hip was performed. Treating post-firearm hip arthritis by THA is challenging, especially in the situation of neglected cases with the presence of an acetabular defect. Concomitant intestinal injury increases the risk of infection with the possibility of coloarticular fistula formation, which could present later. Working with a multidisciplinary team is paramount.
Male ; Humans ; Adult ; Arthroplasty, Replacement, Hip ; Firearms ; Wounds, Gunshot/surgery* ; Acetabulum/injuries* ; Hip Fractures/surgery* ; Arthritis/surgery* ; Spinal Fractures/surgery* ; Reoperation ; Fistula/surgery* ; Treatment Outcome ; Follow-Up Studies ; Prosthesis Failure ; Retrospective Studies

PURPOSE: The aims of this study were to evaluate the dentist's awareness and the actual status of infection control of noncritical dental instruments. MATERIALS AND METHODS: 40 dental clinics in Daejeon, South Chungcheong, North Chungcheong and North Jeolla provinces were surveyed. The questionnaire was delivered to the dentists belonging to those clinics, and the awareness and the practice of infection control were examined. The microbial contamination on the surface of five noncritical instruments (impression gun, light curing unit, 3-way syringe, shade guide, and dental floss dispenser) used by them was measured with an ATP luminometer. Correlation analysis between the awareness and the actual state of infection control was conducted. RESULTS: Awareness and frequency of infection control was highest in the 3-way syringe. Surface disinfection using disinfectant was most frequent in all instruments. 3-way syringes and shade guides were less contaminated than impression guns, light curing units, and dental floss dispensers. CONCLUSION: 3-way syringes had a significant correlation between user awareness of infection control and surface contamination, and the higher awareness, the lower the contamination measurement was shown.
Adenosine Triphosphate ; Dental Clinics ; Dental Devices, Home Care ; Dental Instruments ; Dentists ; Disinfection ; Firearms ; Humans ; Infection Control ; Syringes

Death due to firearm is more common in countries with higher gun ownership such as United States of America compared to countries with restrictive gun ownership such as European countries and Malaysia. However, the increasing number of shooting cases in Malaysia recently should not be overlooked. This study was carried out to investigate the incidence of firearm-related deaths and epidemiology in Klang Valley for 11-year period. The demographic data on the incidence of firearm-related deaths from 2006 to 2016 was collected retrospectively from four government hospitals in Klang Valley. 204 cases of firearm-related deaths were reported with irregular trend of the incidence throughout the 11-year period. The results revealed that most victims were male, aged between 30 to 34 years old and Malaysian citizen. Firearms fatalities were higher among Malaysian specifically Indian, as compared to non-Malaysian. Most firearms fatalities were homicides and took place during late night between 12.00 am to 5.59 am. The highest cause of death was head injury due to gunshot wound. It is hoped that this study will raise awareness to Malaysian citizen regarding firearm-related cases and to develop strategies to overcome the issue of gun violence in Malaysia with appropriate authorities.
firearm fatalities ; firearms epidemiology ; firearms demographic data ; gun violence Klang Valley ; gunshot wound

In March 2014, a 39-year-old Korean male presented with a 6-month history of various nonspecific symptoms including dizziness, fatigue, asthenia, irritability, elevated blood pressure, palpitation, eyestrain, and tinnitus. His occupational history revealed that he had been working as an indoor firing range manager for 13 months; therefore, he was subjected to a blood lead level (BLL) test. The test results showed a BLL of 64 µg/dL; hence, he was diagnosed with lead poisoning and immediately withdrawn from work. As evident from the workplace environmental monitoring, the level of lead exposure in the air exceeded its limit (0.015–0.387 mg/m³). He received chelation treatment with calcium-disodium ethylenediaminetetraacetic acid (1 g/day) for 5 days without any adverse effects. In the follow-up results after 2 months, the BLL had decreased to 9.7 µg/dL and the symptoms resolved. This report represents the first occupational case of lead poisoning in firing ranges in Korea, and this necessitates institutional management to prevent the recurrence of poisoning through this route. Workplace environmental monitoring should be implemented for indoor firing ranges, and the workers should undergo regularly scheduled special health examinations. In clinical practice, it is essential to question the patient about his occupational history.
Adult ; Asthenia ; Asthenopia ; Blood Pressure ; Dizziness ; Edetic Acid ; Environmental Monitoring ; Fatigue ; Firearms ; Fires* ; Follow-Up Studies ; Humans ; Korea ; Lead Poisoning* ; Male ; Military Personnel ; Poisoning ; Recurrence ; Tinnitus

Military personnel often use ammunitions that contain lead. The present study aimed to identify the risks for lead exposure and lead poisoning among workers at indoor firing ranges. A special health examination, including blood lead level (BLL) testing, was performed for all 120 workers at the indoor firing ranges of the Republic of Korea's Air Force, Navy, and Armed Forces Athletic Corps. The overall mean BLL was 11.3 ± 9.4 µg/dL (range: 2.0-64.0 µg/dL). The arithmetic mean of the BLL for professional shooters belong to Armed Forces Athletic Corps was 14.0 ± 8.3 µg/dL, while those of shooting range managers and shooting range supervisors were 13.8 ± 11.1 µg/dL and 6.4 ± 3.1 µg/dL, respectively. One individual had a BLL of 64 µg/dL, and ultimately completed chelation treatment (with CaNa2-ethylenediaminetetraacetic acid) without any adverse effects. These findings indicate that indoor firing range workers are exposed to elevated levels of lead. Therefore, when constructing an indoor firing range, a specialist should be engaged to design and assess the ventilation system; and safety guidelines regarding ammunition and waste handling must be mandatory. Moreover, workplace environmental monitoring should be implemented for indoor firing ranges, and the workers should undergo regularly scheduled special health examinations.
Adult ; Air Pollutants/*blood ; Air Pollution, Indoor ; Drinking ; Edetic Acid/chemistry ; Female ; Firearms ; Humans ; Lead/*blood/chemistry ; Male ; Military Personnel ; Occupational Exposure/*analysis ; Odds Ratio ; Republic of Korea ; Risk Factors ; Spectrophotometry, Atomic ; Young Adult

PURPOSE: HMA (Hot melt adhesive) is a thermoplastic adhesive that is commonly used at glue guns. Nowadays, HMA burns are increasing because of increased consumption of D.I.Y (Do-it-yourself) products and field based experiential learning. Because of patients' lack of knowledge and character of HMA burn, many patients visit the hospital in late period with severe, deep degree burns. At this moment, early surgical intervention may help to shorten the therapeutic period. We planned this study to evaluate the effect of early surgical intervention on shortening the therapeutic period, compared with conservative management. METHODS: This study conducted from April 1, 2013 to April 1, 2015. Thirty seven patients with deep burn wounds due to HMA, who underwent surgical or conservative management were enrolled. Operative group received more than one surgical management, and conservative group were treated by wound dressing. The effectiveness was evaluated by comparing the treatment period between two groups. RESULTS: The average time of treatment was 23.9 day in operative group and 39.1 day in conservative group, and the result was statistically significant (P=0.027). CONCLUSION: The result of this study suggests that surgical treatment and conservative treatment show significant difference in treatment of HMA burns. Therefore, surgical therapy may be considered as a proper choice for treating HMA burn injury patients.
Adhesives ; Bandages ; Burns* ; Firearms ; Humans ; Problem-Based Learning ; Wounds and Injuries

Gunshot wound (GSW) to the spine which was earlier common in the military population is now being increasingly noted in civilians due to easy availability of firearms of low velocity either licensed or illegal combined with an increased rate of violence in the society. Contributing to 13% to 17% of all spinal injuries, the management of complex injury to the spine produced by a GSW remains controversial. Surgery for spinal cord injuries resulting from low velocity GSWs is reserved for patients with progressive neurologic deterioration, persistent cerebrospinal fluid fistulae, and sometimes for incomplete spinal cord injuries. Surgery may also be indicated to relieve active neural compression from a bullet, bone, intervertebral disk, or a hematoma within the spinal canal. Spinal instability rarely results from a civilian GSW. Cauda equina injuries from low velocity GSWs have a better overall outcome after surgery. In general, the decision to perform surgery should be made on consideration of multiple patient factors that can vary over a period of time. Although there have been plenty of individual case reports regarding GSW to the spine, a thorough review of unique mechanical and biological factors that affect the final outcome has been lacking. We review the key concepts of pathogenesis and management of GSW to the spine and propose an algorithm to guide decision making in such cases.
Biological Factors ; Cauda Equina ; Cerebrospinal Fluid ; Decision Making ; Firearms ; Fistula ; Hematoma ; Humans ; Intervertebral Disc ; Military Personnel ; Spinal Canal ; Spinal Cord Injuries ; Spinal Injuries ; Spine* ; Violence ; Wounds, Gunshot*

Unlike the United States, cases of firearm suicides in Korea are rare and are usually limited to military soldiers and policemen. In addition, there is no case report of a suicide by a homemade handgun in Korea. The present victim was a 24-year-old soldier with a fascination for firearms. He had a history of depression and social phobia during his military service. He constructed a homemade handgun from a plastic model gun, also known as a BB gun. During the vacations, he committed suicide with the homemade gun, which caused a penetrating gunshot wound to his chest. The structure and ammunition of the homemade handgun is demonstrated in this report. We have also discussed a few details of the forensic investigation and evaluation of the homemade handgun fatality.
Depression ; Firearms ; Humans ; Korea ; Military Personnel ; Plastics ; Phobic Disorders ; Suicide ; Thorax ; United States ; Wounds, Gunshot ; Young Adult

Forensic interpretation of whether the manner of death is suicide or homicide is very important in death cases due to multiple gunshot wounds. We analyzed 18 death cases from multiple gunshot wounds with Korean military rifles (K-1 and K-2) in the Republic of Korea Army from 2000 to 2011. In cases of the suicide, distance of gun from the body was all contact or near-contact range, except for 1 case of near range. When the selector was set to single shot, the initial entrance wounds were formed on the typical suicidal areas. The bullet tracks, however, did not involve the anatomical regions that would cause immediate incapacitation. The following entrance wounds also were sustained on the typical suicidal areas while the bullet tracks were made in the immediate incapacitation regions. When the selector was set to precision shot or multiple shot, the initial entrance wounds were located on typical suicidal areas, and the entrance wounds resulting from following bullets were gradually moving away form the initial entrance wound due to pop-up effect of the rifle. In cases of the homicide, distance of gun from the body was all distant range and the location of entrance wounds were not significantly related to typical suicidal areas.
Firearms ; Homicide ; Humans ; Military Personnel ; Republic of Korea ; Suicide ; Track and Field ; Wounds, Gunshot

Powered by compressed air, a nail gun is an essential alternative tool to a hammer on any construction site. This useful machine launches nails at high speed, automatically embedding them in a piece of wood in only a fraction of a second. In spite of its convenience, life-threatening and fatal nail gun injuries can occur when a nail gun is misused, such as in a suicide attempt, or when the operator has insufficient training because combustion nail guns are capable of firing projectiles at velocities higher than 150 m per second. Although injuries by nail guns are rarely reported, there have been reports of nail gun injuries to the head and the trachea in Korea. In the emergency room, the authors experienced a patient injured by an accidental shooting of a nail gun while working in construction. In that accident, a nail penetrated the patient's cervical vertebra through the left cheek. This report is aimed at studying medical treatment for patients with penetrating injuries caused by nail guns.
Cheek ; Compressed Air ; Emergencies ; Firearms ; Fires ; Head ; Humans ; Korea ; Nails ; Neck ; Neck Injuries ; Spine ; Suicide ; Trachea ; Wood