Journal of orthopaedic trauma · 2025
The Burden, Management, and Treatment Outcomes of Gunshot-Induced Fractures of the Forearm at a Tertiary Hospital in South Africa.
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Bruce-Brand Douglas, Jakoet Shafique, Van Heukelum Marcus, Le Roux Nicholas, Makhubalo Obakeng, Gerafa Muaad, Burger Marilize, Ferreira Nando
Аннотация
OBJECTIVES: To assess the burden, management, and outcomes of gunshot-induced extra-articular forearm fractures at a tertiary institution in the Western Cape of South Africa.
DESIGN: Retrospective review.
SETTING: Single center, level 1 trauma center.
PATIENT SELECTION CRITERIA: Patients who presented with gunshot-induced extra-articular forearm fractures (OTA/AO 2R2 and/or 2U2) between January 2014 and December 2017 were included.
OUTCOME MEASURES AND COMPARISONS: Clinical examination and radiologic review were used to assess for infection, neurovascular injury, and union.
RESULTS: Ninety-six patients (94% male, mean age 29 ± 11) were included with 45 radius, 36 ulna, and 15 both bone fractures. Associated injuries were identified in 53 (55.2%) patients and included 36 (37.5%) patients who sustained more than 1 gunshot injury, 24 (25%) patients who had associated nerve injuries and 3 (3%) patients who sustained arterial injuries. A total of 51 patients (53.1%) were treated operatively, with a median time to surgery of 4 (interquartile range 2-8) days. One patient presented with a fracture-related infection 2 weeks after external fixation. Of the patients who followed up beyond 12 weeks (n = 53, 55.2%), union occurred in 92.5% (n = 49 of 53), 25 of these were treated operatively and 24 nonoperatively. Isolated radius fractures were malunited in a shortened position in 29.2% (n = 12 of 41) patients, 7 of whom were treated operatively.
CONCLUSIONS: Gunshot-induced forearm fractures had a low infection rate, even without formal wound debridement or bullet removal. Isolated radius fractures commonly healed in a shortened position, highlighting the need for strategies to preserve length during treatment.
LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
DESIGN: Retrospective review.
SETTING: Single center, level 1 trauma center.
PATIENT SELECTION CRITERIA: Patients who presented with gunshot-induced extra-articular forearm fractures (OTA/AO 2R2 and/or 2U2) between January 2014 and December 2017 were included.
OUTCOME MEASURES AND COMPARISONS: Clinical examination and radiologic review were used to assess for infection, neurovascular injury, and union.
RESULTS: Ninety-six patients (94% male, mean age 29 ± 11) were included with 45 radius, 36 ulna, and 15 both bone fractures. Associated injuries were identified in 53 (55.2%) patients and included 36 (37.5%) patients who sustained more than 1 gunshot injury, 24 (25%) patients who had associated nerve injuries and 3 (3%) patients who sustained arterial injuries. A total of 51 patients (53.1%) were treated operatively, with a median time to surgery of 4 (interquartile range 2-8) days. One patient presented with a fracture-related infection 2 weeks after external fixation. Of the patients who followed up beyond 12 weeks (n = 53, 55.2%), union occurred in 92.5% (n = 49 of 53), 25 of these were treated operatively and 24 nonoperatively. Isolated radius fractures were malunited in a shortened position in 29.2% (n = 12 of 41) patients, 7 of whom were treated operatively.
CONCLUSIONS: Gunshot-induced forearm fractures had a low infection rate, even without formal wound debridement or bullet removal. Isolated radius fractures commonly healed in a shortened position, highlighting the need for strategies to preserve length during treatment.
LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.