A retrospective analysis of 36 civilian gunshot fractures.

A critical retrospective analysis was conducted of 36 gunshot fractures admitted from 1985 to 1989 in Finland by using the statistics of the Central Medical Board. The information was analyzed for demographic details and from consumption of hospital resources point of view, with special attention to gunshot injuries to long bones. The fractures were classified by using the grading system of Gustilo et al. into three categories: type A (60%), type B (12.3%), and type C (27.7%). Debridement of wounds was done successfully in two-thirds of the wounds, but was insufficient in nine cases. Fasciotomy was insufficient in seven cases. The fractures were immobilized by external fixation (Hoffmann) in two-thirds of the patients. Primary internal fixation was used in three femoral and one tibial fracture with severe complications. The tibia and femur were the most frequent sites involved, thus accounting for 13 infections. The infection rate, including two septicemias and four cases of osteomyelitis, could have been lower if war surgical principles were accepted or known in the management. The same could be considered in avoiding four compartment syndromes and six ununited fractures.