Outcomes and Management for Ballistic Traumatic Arthrotomies in Children.

OBJECTIVES

To evaluate whether operative irrigation and debridement (I&D) is necessary for the treatment of pediatric traumatic arthrotomies (TAs) secondary to gunshot wounds (GSWs) to prevent joint infections.

DESIGN

Retrospective cohort study.

SETTING

US Academic Level I Trauma Center.

PATIENT SELECTION CRITERIA: Pediatric patients (age 0-17) with TAs secondary to GSW between 2016 and 2023 with at least 1-month follow-up were included. Arthrotomies included shoulder, elbow, wrist, hand, sacroiliac, hip, knee, ankle, or foot joints.

OUTCOME MEASURES AND COMPARISONS: The primary outcome was rate of joint infection between those who received acute operative I&D versus those who received nonoperative management. A subanalysis was completed only comparing "major joints." Within the cohorts, length of antibiotic treatment was compared.

RESULTS

Fifty seven cases of ballistic TA (50 subjects, 82% male, mean age 14.6 years) were included. In total, 31 of 57 joints (54.4%) underwent formal operative I&D with or without fixation, while 26 joints (45.6%) did not. In the operative I&D cohort, 85% were male with a mean age 14.8 years versus 79% male with mean age of 14.3 years in the nonoperative group. Mean follow-up duration was 10.8 months (range 1-56 months) for both cohorts. No joint infections were documented between either group, regardless of treatment ( P = 1.0). In total, 38 TAs were major joints: 23 of 38 (60.5%) received I&D, while 15 of 38 (39.5%) did not. All joints received at least 1 dose of intravenous (IV) antibiotics. Among the operative group, 54.8% of joints received ≤72 hours of IV antibiotics (45.2% received >72 hours), compared with 46.2% of joints in the nonoperative group (53.8% received >72 hours).

CONCLUSIONS

Formal operative I&D was not found to be necessary to prevent joint infection after TA secondary to GSW. Prolonged antibiotic use did not affect rates of infection.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.