Penetrating trauma is a highly visible issue in history, social media, and politics. Crime statistics showed increasing numbers of violations of the law banning assault weapons in Germany. Although these injuries have historically been rare in Germany, we have noticed increasing numbers in our hospital. Studies focusing on these injuries of penetrating trauma are lacking, hence a distinct therapy algorithm is missing.

All penetrating injuries proximal to the wrist and ankle in the years 2016-2021 were analyzed in a retrospective survey. Isolated injuries of hand and foot were excluded. Data were gathered from the clinical information system and the protocol of the emergency medical services. For further analysis we identified three distinct groups: Patients who acquired the injury by an accident (ACCIDENT), self-inflicted (SELF-HARM) or by crime (ASSAULT). The groups were compared using MicroSoft Excel® and Sigma plot® (Jandel, San Rafael, CA).

A total of 961 cases were identified. The analysis showed an increasing number of cases with penetrating injuries from 2016 until 2019. Furthermore, major differences between the groups were revealed. The assault victims (ASSAULT n=117) were mostly male (91%) and non-German (52%). They were more likely to be accompanied by the police (13%), to be intoxicated, to require hospital admission (also to critical care) and to require surgery as compared to the cases of the ACCIDENT (n=484) and SELF-HARM (n=360) group. The SELF-HARM group cases were predominantly female, younger and had psychiatric comorbidities.

The cause of penetrating trauma injury is important and can provide information crucial to the management of the patient. The emergency treatment of assault victims is challenging due to the particular circumstances of these cases. Optimal preparation and anticipation of the accident and emergency staff are necessary to deal with these patients. In summary, assault victims had more serious injuries than the other groups.