Citation

Nguyen MP, Reich MS, O'Donnell JA, Savakus JC, Prayson NF, Golob JF, McDonald AA, Como JJ, Vallier HA. J. Orthop. Trauma 2017; 31(6): 330-333.

Affiliation

Study performed within the MetroHealth System, affiliated with Case Western Reserve University, Cleveland, OH, USA.

Copyright

(Copyright © 2017, Lippincott Williams and Wilkins)

DOI

10.1097/BOT.0000000000000823

PMID

28230571

Abstract

OBJECTIVES: The purpose of this study is to characterize the demographics, interventions, infection rates, and other complications following intra-articular gunshot wounds.

DESIGN: Retrospective review. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: 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. INTERVENTIONS: 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%). MAIN OUTCOME MEASURES: Incidence of deep infection.

RESULTS: Two joints (3.6%) developed deep infections. Both had associated vascular injuries. Patients with vascular injuries were at higher risk of infection compared to those without vascular injury (28.6% vs 0.0%, p =0.02). Two of 24 (8.3%) injuries that were originally managed non-operatively required delayed surgical procedures, one for bullet removal and one for ulnar nerve allograft. No patient treated non-operatively developed an infection.

CONCLUSIONS: The incidence of infection after intra-articular gunshot injuries is low with the routine use of antibiotic prophylaxis. In the absence of intra-articular pathology, intra-articular gunshot injuries do not appear to necessitate surgical debridement in order to decrease the risk of infection. Patients with vascular injury deserve special attention as they are at higher risk of infection. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Language: en