Civilian gunshot injuries in orthopaedics: a narrative review of ballistics, current concepts, and the South African experience

Abstract

The incidence of civilian gunshot injuries is on the rise worldwide.Unfortunately, there is a lack of high-level evidence guiding management. The treatment of orthopaedic injuries from gunshots is complex and requires consideration of multiple aspects, including energy transfer to the tissue, severity of the wound, possible contamination, presence of fractures and associated injuries. With this narrative review we aim to discuss some of the relevant ballistics, current concepts, and controversies in the general management of civilian gunshotrelated orthopaedic injuries based on the available evidence and personal experience. Important points which will be highlighted are the initial management in the emergency room, the assessment and management of soft tissue injuries, associated injuries, use of antibiotics, indication and techniques for fracture fixation, and gunshot injuries to joints.

Optimising the Orthopaedic Trauma Society Open Fracture Classification system: a proposal for modification in the context of high civilian gunshot fractures

“…Civilian gunshot injuries are inflicted by low-velocity handguns, which generally result in less tissue damage than high-velocity weaponry such as rifles. [ 10 , 15 , 16 ]. Energy transfer also significantly contributes to the magnitude of injuries sustained from gunshots.…”

“…[ 2 , 23 , 24 ]. The literature on civilian gunshot classifications and clear management protocols is scarce [ 2 , 10 ].…”

Acute Management of Open Long Bone Fractures: A Scoping Review

“…Ballistic injuries in the civilian population are typically classified as low-velocity or high-velocity, with low-velocity injuries predominating. [8][9][10] However, classifying these injuries using the Gustilo-Anderson classification is controversial among orthopedic traumatologists. Without a proper classification for ballistic fractures, developing treatment strategies remains challenging and underrepresented in the literature.…”

Multi-stage management of a right hip gunshot injury; Case report

“…Despite an increasing rate of civilian low-velocity gunshot injuries worldwide, there remains a lack of evidence-based guiding management or treatment standards [ 1 , 2 ]. More than 30,000 fatal and 70,000 non-fatal injuries result from firearms each year in the USA [ 3 ].…”