The management of civilian intra-articular gunshot wounds: Treatment considerations and proposal of a classification system (original) (raw)
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Infection and complications following low-velocity intra-articular gunshot injuries
Journal of orthopaedic trauma, 2017
The purpose of this study is to characterize the demographics, interventions, infection rates, and other complications following intra-articular gunshot wounds. Retrospective review. Level I trauma center. Fifty-three patients with 55 civilian low-velocity intra-articular gunshot injuries with a minimum of four weeks follow-up were included in the study. Seven patients had associated vascular injuries. Most patients (84.9%) received antibiotic prophylaxis, consisting most often of cefazolin (93.3%). Based on injury pattern and surgeon preference, joint injuries were either treated non-operatively (43.6%), with surgical debridement only (20.0%), with surgical debridement plus fracture fixation and/or neurovascular repair (32.7%), or with percutaneous fracture fixation without debridement (3.6%). Incidence of deep infection. Two joints (3.6%) developed deep infections. Both had associated vascular injuries. Patients with vascular injuries were at higher risk of infection compared to t...
Management of Gunshot Fractures to the Extremities - A Narrative review
Journal of orthopaedic reports, 2023
Abstract Objectives To review the literature regarding antibiotic protocols, indications for formal irrigation, timing of debridement, and outcomes following fixation for low and high velocity gunshot fractures. The limitations in the literature will also be discussed.
The Israel Medical Association journal : IMAJ, 2009
Gunshot wounds impose a continuous burden on community and hospital resources. Gunshot injuries to the extremities might involve complex soft tissue, bone, vascular, musculotendinous, and nerve injuries. A precise knowledge of anatomy is needed to evaluate and treat those injuries. To review our experience with gunshot wounds to the extremities. We retrospectively reviewed all civilian cases of gunshot wounds to the limbs treated in our institution during 2003-2005. Altogether, we evaluated 60 patients with 77 injuries. Of the 60 patients 36 had fractures, 75% of them in the lower extremity and 81% in long bones. The most common fixation modality used was external fixation (33%), followed by intramedullary nailing (25%). This relatively high percentage of fracture treated with external fixation may be attributed to the comminuted pattern of the fractures, the general status of the patient, or the local soft tissue problems encountered in gunshot wounds. About one-fifth of the fractu...
Infection rates and treatment of low-velocity extremity gunshot injuries
Journal of orthopaedic trauma, 2017
To determine the rates of infection in low-energy gunshot wounds (GSWs) to the extremity. Retrospective review. Level I trauma center. Patients (N=140) with at least 90-day follow-up for extremity-only low-energy GSW injuries from 2010-2014 were retrospectively reviewed. Treatment was recorded, including type and duration of antibiotics and details of non-operative and operative management. s MAIN OUTCOME MEASURES:: The rates of superficial and deep infections. The overall infection rate was 15.7% (22 patients), and the deep infection rate was 3.6% (5 patients). Age, gender, and injury location were similar between the groups that did and did not receive antibiotic prophylaxis. Injury Severity Scores were higher in the group that did receive antibiotics. Regarding soft tissue-only injuries, antibiotic prophylaxis trended toward a lower rate of overall infection versus no antibiotic prophylaxis (6.1% vs. 25.9%, respectively, p=0.07). Multiple doses of antibiotics did not reduce the r...
Management of civilian gunshot injuries of the femur A review of the literature
Injury, 1998
Gunshot fractures of the femur are becoming more commonplace in modern civilization. The initial assessment must accurately document the vascular and neurological status of the limb as well as the characteristics of the fracture. Low velocity gunshot wounds require a brief course of broad spectrum intravenous prophylactic antibiotics and limited surgical debridement of the wound. Definitive stabilization should consist of locked, reamed, intramedullary nailing for low velocity injuries, and non-reamed nailing for high velocity injuries. External or plate fixations are best reserved for the more severe Grade IIIC injuries. Successful limb salvage is most dependent on the associated vascular injury, while neurological injury is a major determinant of long-term disability.
Treatment of purulent-inflammatory complications in a combat gunshot trauma.
Modern Medical Technology, 2019
Autors: Fomin O. O., Kovalchuk V.P., Fomina N.S., Zheliba M.D., Dobrovanov Oleksandr, Karol Kralinsky. Purpose of the study. Justification of the effectiue treatnxent tactics of the wounded with the gunshot fractures of the long bones. Materials and methods. The exarnination and treatment of 123 wounded'with gunshot fractures were perform'ed. All wounded were diuided into 3 groups according to ctinical observation. For the first clinical group the traditional treatment of the combat fractures with osteometallosynthesis out of injury zone was done. In the second group treatment was added with negatiue pressure therapy. In the third clinical group Wounded got a VAC - associated therapy with the proposed of counter-druinage of wounds with the flow-washing inigation with antiseptic solutions Decasan + 3% hgdrogen peroxyde. A bacteriological study of the wounds exudates was carried out, and the sensitivity of microorganisms to antibiotics was determined.
First Intervention in Firearm Injuries and Management of Compliations
Journal of Contemporary Medicine, 2021
Soft tissue, neurovascular injuries and bone fractures are seen in the extremity as a result of firearm injuries. The fact that these injuries are violent and that forensic incidents are more frequent, especially in young people, make treatment more difficult. Our aim in this study is to evaluate the effects of a stepwise approach to neurovascular, soft tissue injuries and bone fractures on the final treatment results in firearm-related musculoskeletal injuries. Material and Method: This study retrospectively evaluated patients over the age of 18 who had firearm-related extremity injuries and received surgical treatment between 2015 and 2020.Demographic characteristics of the patients, injury sites, accompanying neurovascular injuries, patients who received first aid, final treatment results, developing complications and management of the complications were evaluated. Results: The mean age of 54 patients (52 males, 2 females) in the study was 28.3 (age range 19-61) years. Twenty-nine (53.7%) lower extremity, 20 (37.1%) upper extremity, and 5 (9.2%) both lower and upper extremity injuries were detected. Vascular injury was detected in 3 (5.5%) patients, amputation in 3 (5.5%) and nerve injury in 6 (11.1%) patients. Five (9.2%) of 6 patients, underwent fasciotomy in the early period because the development of compartment syndrome was highly anticipated. In one of the patients, fasciotomy was performed due to the development of the compartment syndrome during the follow-up. The most common complication we encountered was loss of joint range of motion in 7 (12.9%) patients. Conclusion: Switching to definitive treatment after antibiotherapy, bone fixation and serial debridements in the early period with a multidisciplinary and damage-controlled approach to firearm injuries positively affects the success of treatment. In addition, necessary consents should be obtained to minimize medico-legal problems.
The Iowa Orthopaedic Journal, 2015
Lower extremity injuries secondary to low-energy gunshot wounds are frequently seen in the civilian populations of urban areas. Although these wounds have fewer complications than high-energy gunshot injuries, the functional and psychological damage is still significant making appropriate timely orthopaedic treatment and follow-up imperative. The purpose of this study is to present our outcomes in the treatment of low-energy gunshot wounds in a civilian population at an urban, level one trauma center in patients treated by a standard protocol. One hundred and thirty three patients who sustained 148 gunshot wound injuries were treated at our level one trauma center between January 1(st), 2009 and October 1(st), 2011. Following IRB approval, we extracted information from medical records regarding hospital course, length of stay and type of operative or non-operative treatment. If available, injury and post-operative radiographs were also reviewed. Patients were contacted by telephone ...