Decision-Making in Gunshot Muskuloskeletal Injuries: A Systematic Review

Abstract

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.