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Americans shooting themselves in the foot: the epidemiology of podiatric self-inflicted gunshot wounds in the United States

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The United States is home to about one third of all firearms worldwide, with 90 guns for every 100 American citizens.1 It is therefore perhaps not surprising that gunshot wounds (GSWs) are among the leading causes of injury in the US.2,3 The statistics indicate that 93% of the wounded are men, 56% are unemployed, and 56% tested positive for drugs or alcohol after the incident.46 As the incidence of GSWs is increasing, epidemiological studies that provide insight into their general nature and the circumstances in which they occur are useful for developing preventive education. Further, an understanding of terminal ballistics is important for determining the appropriate clinical management of GSWs.

The extent of injury inflicted by a GSW is determined by the energy of the primary projectile, its dissipation in the tissue, and the generation of secondary projectiles following osseous injury. The kinetic energy of a bullet before impact is equal to half its mass multiplied by its velocity squared; the energy of a projectile thus increases exponentially with its velocity. In order to maximise mass (and minimise energy loss caused by air resistance), bullets are often made with pointed or rounded tips from metals with a high specific gravity,…