Trauma by firearms has become more frequent across the world [1] . A study conducted in Mexico from 2008 to 2010 was an increase of 800% bullet injuries [2] . In the UK, the rate of injuries from firearms grew by 30% from 1998 to 2000 [3] . These injuries by firearms occur in contexts that differ from one region to another: crime [3] , armed conflicts [1] [4] - [6] and the socio-political events [4] - [6] .

Since the mass arrival of Rwandese refugees in the Eastern Democratic Republic of Congo (DRC) in 1994, successive wars were taking place for the sake of liberation. Due to the proliferation of foreign and national armed groups, surgeons practicing in this part of the country regularly received patients wounded by firearms. These lesions, dominated by open fractures, often complex in terms of bone crash, loss of soft tissue lesions and association, are a challenge for the clinician. In our working conditions characterized by a lack of technical equipment on one hand and the poverty of the population on the other hand, the management of these lesions poses real problems [7] [8] .

The present work aims to take state’s place into account to encourage policy makers to provide hospitals in appropriate equipment in charge of fractures firearms taken and increase actions to restore peace in this part of the country.

Our study concerned the too young subjects with a mean age of 29.9 years. Nearly 70% are aged between 21 and 40 years. Our results are similar to those reported by other authors [2] [3] [5] . Population study of Saidi is relatively older than ours because they record an average age of 39.12 years and a peak between 40 and 49 years [9] . The young age of the population of our study can be explained by the socio-economic situation and endemic activism facing the Eastern DRC. In this age, in order to ensure the survival of their families, young man are engaged in different activities including trade and exploitation of minerals. In this environment of insecurity, they are regularly subjected to be attacked by armed men to extort their properties. Besides this age, we find the loyalist militaries, youths recruited by the lords of war and the self-defense groups.

About sex, men predominate significantly (86.2%), with a sex ratio of 6:1. Male dominance firearms trauma is emphasized by other authors. It is 100% for Sarre [5] and 99.9% in the Hugenberg [10] . Saidi notes a sex ratio of 10:1 [9] while Moye-Elizalde GA records a sex ratio of 27:1 [2] .

Regarding victims’ residences, most of them 96 (78.2%) are coming from the countryside. Bukavu, the county town of the South-Kivu Province and hosting state institutions is relatively secured. Nevertheless, the different lords of war are spread over the rest of the countryside which explains high proportion of victims’ number coming from countryside.

Concerning the victims’ statue, it emerges that civilians cases are more concerned than the militaries one with 71 (57.7%) cases. The relatively high proportion of civilians is related to insecurity result of traffic abnormal firearms. Our results differ from those found by Saare in Bissau, for whom all of their injuries consisted of the militaries [5] . Moye-Elizalde in Nigeria [2] and Dogba in Ivory Coast [4] also noted a predominance of civilians.

In our study the circumstances of fracture’s occurrence are represented by reprisal. For Dogba in Ivory Coast, gunshot fractures are the work of the militaries to restore order during sociopolitic demonstrations [4] while Saidi in Kenya criminalize attacks perpetrated by thieves [9] .

The lower limbs are most affected by ballistic fractures in our study. This distribution of lesions in gunshot injuries differs from one author to another. For Owen, fractures by firearms are equitably distributed to lower and higher limbs [11] . However, other authors confirm the predilection of gunshot injuries to the lower limbs [1] [2] [9] [12] [13] . This preponderance of lower limbs fractures can be explained by their low lethality compared to lesions of the head and trunk which kill quickly on the field and are not recorded in the structures of care [9] [14] .

When receiving patients, we gave them double antibiotics and tetanus prophylaxis. The type of antibiotic and duration of administration is the subject of different opinions as regarding the literature. It is a short-term antibiotic prophylaxis instituted early for Ducourau [15] and Bowyer [16] . Rump [17] and Tejan [18] , recommend prehospital antibiotics intent of curative at the time of evacuation patient as soon as possible.

Debridement and irrigation are essential practices in the management of traumatic injuries by firearms [1] [8] [11] [18] . Keeling restored an irrigation at least 9 liters of physiologic serum per wound [12] . This generous irrigation with physiologic serum is not affordable in our working conditions due to the lack of our patients’ means. Cleaning the wound by using tap water could also give a significant service. A delayed primary suture and skin grafts has led to the healing of soft tissues as recommended by other authors [12] [14] [16] [17] .

Concerning the treatment of long bones, we have focused on orthopedic procedures in 64 (50%) due to the lack of external fixators. However, for some cases external fixation was performed, attitude advocated by some authors [4] [12] [19] . Yet osteosynthesis with implants is increasingly used to treat open gunshot fractures [2] [4] [12] [19] . In a total of 559 fractures, Moye-Elizalde resorted to conservative treatment in 44.3% of cases, the external fixator in 37% of cases, the plate screwed in 21% and intramedullary nailing in 17% of cases [2] .

We found 9 (7.3%) cases of osteitis. This infection rate is close to the results of Keeling (8%) [12] and Moye-Elizalde (6%) [2] , but is far inferior to those reported by Saidi (35.5%) [9] and Lambert (60%) [13] . Lin does not store any infection in his study [20] . Infection ballistic fractures depend on several factors including delay and quality of support [16] .

We regretted 1 (0.8%) death. The mortality rate was 7.72% for Moye-Elizalde [2] and 5.6% for Saidi [9] . Our very low mortality rate does not reflect the reality because firearm’s victims with bad prognosis die before reaching a medical training and are not therefore recorded [2] [10] .

On account of the abnormal movement of gunshot, fractures by firearms occurring in the eastern DRC are frequently recorded in care institutions of Bukavu. They concern young males living in the rural areas in most civil cases and occur in a context of reprisal. They mainly affect the bones of the lower limbs and the management of these fractures is mainly orthopedic. A study on fracture by firearms should be carried in the area where people have been wounded. Reducing the flow of gunshot could decrease the rate of fractures by firearms.