Civilian Gunshot Injuries of the Humerus

Abstract

An institutional review board-approved retrospective study was performed at a level 1 trauma center to evaluate the adequacy of current treatment guidelines in the management of humerus fractures following civilian gunshot injuries. Fifty-four patients with a humerus shaft fracture from a low-velocity gunshot wound were included in the study. Twenty-nine patients were treated nonoperatively, while 25 patients had operative treatment, with 14 undergoing plate fixation, 6 having application of an external fixator, 3 receiving an intramedullary rod, and 2 having irrigation and debridement with fracture immobilization provided by a brace. Patient demographics and injury data, radiographic analyses, and treatment complications were recorded. Healing of soft tissue and bony injuries, including fracture alignment in patients treated nonoperatively, was also evaluated. Fifty-two of 54 patients had minor soft tissue damage and were treated successfully with minimal local wound care. Two patients with larger wounds required extended wound care with repeated irrigation and debridement. Overall, 47 of 54 fractures healed with the primary mode of treatment, and 7 patients went on to nonunion requiring further intervention. Of the patients treated nonoperatively, the average deformity was 16.5°±7.4° in the coronal plane and 4.4°±4.0° in the sagittal plane. This study supports the view that the majority of humerus fractures following civilian gunshot wounds may be treated nonoperatively, with a select group of patients requiring surgical stabilization.

Evaluation of Gunshot Wounds in the Emergency Department

“…[13] The rate of surgical treatment for injuries to the extremities and femur fractures in civilian patients is 46%. [14] In the penetrating abdominal injury guide, the rate of early laparotomy in thoracoabdominal injuries is 23%, while the rate of laparotomy in general is 48%. The rate of local wound exploration is 47%.…”

“…The Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Injury Severity Score (ISS), and the Trauma and Injury Severity Score (TRISS) probability of survival for blunt trauma and penetrating trauma were calculated for all patients. The extent of injury was graded according to the ISS as: mild (1)(2)(3)(4)(5)(6)(7)(8), moderate (9)(10)(11)(12)(13)(14), severe (15)(16)(17)(18)(19)(20)(21)(22)(23)(24) and critical (≥25). [2] In the present study, the evaluated parameters included mechanism of injury, results and types of diagnostic imaging, modality of treatment, consulted departments, hospitalization ratio, length of stay and complication rate and type.…”

Firearm-Related Injuries—Wound Management, Stabilization, and Associated Injuries

“…Lead has been shown to inhibit endochondral ossification through interference of the Wnt/beta-catenin pathway in vivo 37 . However, reported nonunion rates of low-energy ballistic fractures are similar to those of closed fractures 38-40 . Thus, the clinical significance of retained metallic lead foreign bodies on inhibition of endochondral ossification is unclear.…”

Ballistic Trauma of Limbs

“…Hansley [15] used the external fixator in 22% of his patients. Over 54 patients treated for fracture of the humerus by firearm, Vaidya [16] used external fixator for only 6 patients and 25 underwent non operative treatment. The scapulo-brachio-antebrachio-palmar plaster with chest strap that we used has the benefit of immobilizing the shoulder joint which remains stabilized by the chest strap.…”