A comparison of external fixation and locked intramedullary nailing in the treatment of femoral diaphysis fractures from gunshot injuries

Polat, Gökhan; Balcı, Halil İbrahim; Ergin, Ömer; Asma, Ali; Şen, Cengiz; Kılıçoğlu, Önder

doi:10.1007/s00068-017-0814-6

Cited by 14 publications

(11 citation statements)

References 25 publications

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“…The wound, fracture, and definitive fixation types were identified as significant predictors of outcomes in this study. Greater severity, complexity, and invasiveness of these factors were associated with increased odds of complications and poor functional outcomes, aligning with previous literature showing their importance in relation to infection, healing, stability, alignment, function, and quality of life in open proximal femoral fractures 9-12 . However, measuring and classifying these factors present certain limitations and challenges.…”

Section: Discussionsupporting

confidence: 86%

Functional and Radiographic Outcomes of Open Proximal Femoral Fractures Caused by Gunshot Wounds in Yemen

Hutaif,

Al-Moaish,

Al-fadliy

2024

JBJS Open Access

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Background: Open proximal femoral fractures caused by gunshot wounds are rare but devastating injuries that pose considerable challenges for prognosis and management. The aim of this study was to evaluate the functional and radiographic outcomes of patients with open proximal femoral fractures caused by gunshot wounds treated at 3 Level-I trauma centers in Yemen and to identify the factors that influence them. Methods: We prospectively enrolled 174 patients with open proximal femoral fractures caused by gunshot wounds. The fractures were classified according to the Gustilo-Anderson and OTA/AO systems. The primary outcome measures were fracture union, infection, and functional outcomes. The secondary outcome measures were the Harris hip score (HHS) and the Short Form-36 (SF-36) health survey score. We performed multivariable logistic regression modeling to identify the predictors of complications and poor functional outcomes. Results: The overall rate of fracture union was 87%. The complication rates were 18% for infection, 13% for nonunion, 23% for reoperation, 12% for delayed union, 4% for osteonecrosis, 6% for heterotopic ossification, and 2% for amputation. The mean HHS at the final follow-up was 78.4, and the mean SF-36 score was 67.3. Conclusions: Open proximal femoral fractures caused by gunshot wounds are associated with high rates of complications and poor functional outcomes in Yemen. Early debridement, appropriate fixation, infection control, and adequate soft-tissue coverage are essential for achieving satisfactory results. The type of wound, the type of fracture, and the type of definitive fixation are significant predictors of the outcomes. Future studies should compare different fixation methods and evaluate the long-term outcomes and complications of these injuries. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionsupporting

confidence: 86%

Functional and Radiographic Outcomes of Open Proximal Femoral Fractures Caused by Gunshot Wounds in Yemen

Hutaif,

Al-Moaish,

Al-fadliy

2024

JBJS Open Access

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“…The study concluded that infection was more related to the extent of damage than to the method of fixation and highlighted debridement. Polat [12] analysed 107 low energy diaphyseal femur fractures, comparing delayed external fixation and delayed nailing and no diferences were found between these methods. Nikolic [8] , analysing 41 subtrchanteric fractures in military, compared external fixation and plaster of Paris, finding high rate of complications in both.…”

Section: Resultsmentioning

confidence: 99%

“…The main limitation of these studies was the low level of evidence. In the present review, the study of Polat [12] performed a retrospective comparative study with 107 gunshot-induced femoral fractures in 99 patients and divided them into 2 groups, 1 treated with an intramedullary nailing and another with external fixation. The mean follow-up time was 76.3 months and no significant difference was observed in relation to the rates of postoperative complications.…”

Section: Setting Of Management and Complications In Low Energy Injuriesmentioning

confidence: 99%

Decision-Making in Gunshot Muskuloskeletal Injuries: A Systematic Review

Mesquita

Freitas²,

Arcoverde

et al. 2019

International Journal of Orthopaedics

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BACKGROUND: From January 2015 until January 2017, the treatment of patients with gunshot musculoskeletal injuries performed by the authors in an urban Trauma Hospital of Rio de Janeiro brought some controversies about surgical methods in Emergency Orthopedic Surgery. Therefore, data were revised in the literature to establish decision making in the primary management of these injuries. QUESTION/PURPOSE: What are the aspects of decision-making in primary management of gunshot musculoskeletal injuries about fracture initial stabilization, soft-tissue management and antibiotic therapy? MATERIAL AND METHODS/ RESULTS: The authors researched individually the combination of the terms "Fractures", "muskuloskeletal injuries", "Gunshot", "Management", "Treatment", "Trauma" and "Orthopedic Surgery" in MEDLINE, PUBMED, SCIELO and LILACS. 231 articles were related to Orthopedics and Traumatology. After criteria had been set, 15 articles were selected and organized in TABLES. CONCLUSION: Gustillo grade I and II fractures treatment is based on debridement, immediate/early definitive internal fixation, and antibiotic therapy. Gustillo grade IIIA fractures can be treated with debridement and antibiotic therapy, reobservation of soft tissue conditions followed by definitive osteosynthesis. Gustillo grade IIIB and IIIC fractures of the long bones and joints can be treated with initial debridement and delayed internal fixation. More high level studies are necessary to determine if it is advantageous external fixation prior to definitive treatment of these fractures.

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“…Gunshot femur fractures Gustillo type I are quite prevalent and their treatment has some controversy. Polat [15] analyzed 107 low energy gunshot-induced diaphyseal femur…”

Section: Grade Iiicmentioning

confidence: 99%

“…Immediate fixation was performed in fractures of Grade 1 with infection rate equal to 0%. Polat [15] analyzed 107 grade I diaphysial femur fractures, comparing late external fixation and late fold, and no differences were found between these methods.…”

Section: Gustillo III Gunshot Fracturesmentioning

confidence: 99%

Gunshot Fractures to the Limbs: A Review of Fixation Methods

Ribeiro¹,

Gomes²,

Paulo³

2019

J Orthop Rheumatism

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Background:The authors had intensive experience with gunshot fractures in wounded civilian and military in the war against organized crime in Rio de Janeiro. From the many difficulties and controversies, came the necessity to search for scientific evidence to establish management and treatment to these challenging injuries.Purpose: Make a revision about fixation methods in the management and treatment of gunshot fractures to the limbs. Material and methods/results:The author researched the combination of the terms "Fractures", "Gunshot", "Treatment", "Fixation" and "Orthopedic Surgery" in MEDLINE, PUBMED, SCIELO and LILACS. Conclusion:Gunshot fractures Grade Gustillo I and II can be treated with debridement plus immediately/early internal fixation; Fixation methods remain controversial in Gustillo III fractures. More high level studies are necessary to establish protocols in Gustillo III gunshot fractures.

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A comparison of external fixation and locked intramedullary nailing in the treatment of femoral diaphysis fractures from gunshot injuries

Abstract: Level 3 retrospective comparative clinical study.

Cited by 14 publications

References 25 publications

Functional and Radiographic Outcomes of Open Proximal Femoral Fractures Caused by Gunshot Wounds in Yemen

Functional and Radiographic Outcomes of Open Proximal Femoral Fractures Caused by Gunshot Wounds in Yemen

Decision-Making in Gunshot Muskuloskeletal Injuries: A Systematic Review

Gunshot Fractures to the Limbs: A Review of Fixation Methods

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