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

Document Type : RESEARCH PAPER


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


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


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