Characteristic Features and Outcomes of Open Gunshot Fractures of Long-bones with Gustilo Grade 3: A Retrospective Study

Document Type : RESEARCH PAPER

Authors

Department of Orthopaedic Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background: The incidence of gunshot injuries is growing, and civilian orthopedics should be more aware of the 
treatment and consequences of these injuries. This study aimed to describe the characteristic features and complications 
of gunshot injuries to long-bones.
Methods: A total of 50 patients who presented with an open gunshot fracture of the tibia, humerus, and femur in the 
emergency room of our hospital were included in this study. Primary irrigation and debridement, as well as prophylactic 
antibiotics, were administered in the emergency room. The treatment was performed either conservatively (n=4) or 
surgically (n=46). The external fixator, nailing, or plating was used for surgical fixation. 
Results: The mean age and follow-up duration of the patients were 32.3±9.9 years and 13.1±5.6 months, respectively. 
The most common injured long bone was the femur (32 of 50). Regarding the Gustilo grade, IIIa, IIIb, and IIIc were 
observed in 37, 7, and 5 patients, respectively. The Masquelet technique was used for 7 (14%) patients, and 12 (24%) 
cases had skin flaps. Furthermore, the vascular injury was present in 5 (10%) patients, and Malunion of the fracture site 
was observed in 5 (10%) cases. Nonunion of the fractured bone occurred in 13 (26%) patients that was significantly 
associated with the presence of vascular injuries (P=0.02). Postoperative infection occurred in 9 (18%) patients and 
was significantly associated with the presence of skin flap (P=0.014). 
Conclusion: Gunshot injuries of long bones are associated with a high incidence of post-treatment complications, 
such as infection and nonunion, and therefore, more intensive care should be taken to avoid these complications.
Level of evidence: III

Keywords

References

  1. Crandon IW, Bruce C, Harding HE. Civilian cranial gunshot wounds: a Jamaican experience. The West Indian medical journal. 2004;53(4):248-51.
  2. Ballesteros MF, Webb K, McClure RJ. A review of CDC’s Web-based Injury Statistics Query and Reporting System (WISQARS™): Planning for the future of injury surveillance. Journal of safety research. 2017;61:211-5.
  3. Penn-Barwell JG, Brown KV, Fries CA. High velocity gunshot injuries to the extremities: management on and off the battlefield. Current reviews in musculoskeletal medicine. 2015;8(3):312-7.
  4. Burg A, Nachum G, Salai M, Haviv B, Heller S, Velkes S, et al. Treating civilian gunshot wounds to the extremities in a level 1 trauma center: our experience and recommendations. The Israel Medical Association journal. 2009;11(9):546.
  5. Mauffrey C. Management of gunshot wounds to the limbs: A review. The internet Journal of orthopaedic surgery. 2006;3(1).
  6. Maqungo S, Kauta N, Held M, Mazibuko T, Keel MJ, Laubscher M, et al. Gunshot injuries to the lower extremities: issues, controversies and algorithm of management. Injury. 2020;51(7):1426-31.
  7. Dougherty PJ, Vaidya R, Silverton CD, Bartlett C, Najibi S. Joint and long-bone gunshot injuries. JBJS. 2009;91(4):980-97.
  8. Cross III WW, Swiontkowski MF. Treatment principles in the management of open fractures. Indian journal of orthopaedics. 2008;42(4):377.
  9. Kim PH, Leopold SS. Gustilo-Anderson Classification. Springer; 2012.
  10. Wiss DA, Brien WW, Becker Jr VI. Interlocking nailing for the treatment of femoral fractures due to gunshot wounds. The Journal of bone and joint surgery. American volume. 1991;73(4):598-606.
  11. Ogunlusi J, Olasinde A, Ikem I, Davids T. Gunshot fractures of tibia and femur-excellent results with reamed bone marrow graft and interlocking nailing. East African Medical Journal. 2011;88(10):337-43.
  12. Hilton T, Kruger N, Wiese K, Martin C, Maqungo S. Gunshot tibia fractures treated with intramedullary nailing: A single centre retrospective review. SA Orthopaedic Journal. 2017;16(1):32-8.
  13. Thakore RV, Francois EL, Nwosu S, Attum B, Whiting P, Siuta M, et al. The Gustilo–Anderson classification system as predictor of nonunion and infection in open tibia fractures. European Journal of Trauma and Emergency Surgery. 2017;43(5):651-6.
  14. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. The Journal of trauma. 1984;24(8):742-6.
  15. Brinker MR, Bailey DE, Jr. Fracture healing in tibia fractures with an associated vascular injury. The Journal of trauma. 1997 Jan;42(1):11-9.
  16. Hajializade M, Moghtadaei M, Mirzaei A, Kordkandi SA, Babaheidarian P, Pazoki-Toroudi H, et al. Significant effect of simvastatin and/or ezetimibe-loaded nanofibers on the healing of femoral defect: An experimental study. Materials Science and Engineering: C. 2020;111:110861.
  17. Amici J, Rogues A, Lasheras A, Gachie J, Guillot P, Beylot C, et al. A prospective study of the incidence of complications associated with dermatological surgery. British Journal of Dermatology. 2005;153(5):967-71.
  18. Sabino J, Polfer E, Tintle S, Jessie E, Fleming M, Martin B, et al. A decade of conflict: flap coverage options and outcomes in traumatic war-related extremity reconstruction. Plastic and reconstructive surgery. 2015;135(3):895-902.
  19. Ukai T, Hamahashi K, Uchiyama Y, Kobayashi Y, Watanabe M. Retrospective analysis of risk factors for deep infection in lower limb Gustilo–Anderson type III fractures. Journal of Orthopaedics and Traumatology. 2020;21(1):1-7.
  20. Tolera M, Marami D, Abate D, Dheresa M. Are invasive procedures and a longer hospital stay increasing the risk of healthcare-associated infections among the admitted patients at Hiwot Fana specialized university Hospital, eastern Ethiopia? Advances in preventive medicine. 2020;2020.
The Archives of Bone and Joint Surgery
Volume 10, Issue 5
May 2022
Pages 453-458

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History

  • Receive Date: 30 October 2020
  • Revise Date: 27 February 2021
  • Accept Date: 24 July 2021

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