Gunshot-Related Injuries to the Foot & Ankle: Review Article

Abstract

Gunshot-related injuries remain a significant and important cause of global morbidity and cost. The foot and ankle has certain anatomic and functional considerations that make gunshot-related injuries challenging to manage. While the scientific literature regarding gunshot-related injuries is extensive, little of the existing literature focuses on the foot and ankle. While principles of management can be somewhat extrapolated from the current literature, an understanding of the body of work specific to the foot and ankle is valuable. Therefore, this review provides an overview of ballistic injuries to the foot and ankle as well as specific guidelines to aid surgeons in treating these difficult injuries. Level of Evidence: Level V, expert opinion.

Low-Flow Ankle Arthroscopy for Gunshot Wounds With Retained Intra-Articular Ballistic

“…While it is recommended that retained intra-articular fragments are surgical removed, this is commonly completed using an open arthrotomy when within the ankle joint. 4 There are many advantages of an arthroscopic approach to surgical removal of intra-articular ballistic missiles when compared with an open arthrotomy ( Table 1 ). When compared with an open arthrotomy without arthroscopy, which uses blind sweeps for debridement, an advantage of a low-flow arthroscopic technique allows for direct visualized debridement of the tract of the ballistic missile, which can decrease the risk of infection and retained intra-articular foreign bodies.…”

“…Low-velocity GSWs are attributed to projectiles with a velocity of <350 m/s and generally cause less severe injuries compared with greater-velocity weapons. 4 Low-velocity GSWs typically are caused by handguns and are more common in the civilian population. In addition to the velocity of the projectile, other factors that are involved in determining the severity of the injury include total kinetic injury possessed by the projectile at the time of impact, stability and entrance profile of the projectile, caliber, construction, and configuration of the bullet as well as depth and path traveled by the projectile within the body.…”

Follow the Shoestring: A Unique Case of Bullet Extraction

“…The majority of literature discussing bullet removal from the extremities involves arthroscopy for intra-articular injuries or surgical intervention involving fractures of the foot [ 6 ]. In regards to non-complicated soft tissue injures, management typically involves superficial irrigation as opposed to formal surgical irrigation and debridement [ 3 , 7 , 8 ]. The issue we faced was a non-complicated soft tissue injury, specifically affecting the foot.…”

“…Injuries to the foot are particularly challenging due to anatomical and functional considerations related to that region. A preponderance of gunshot injuries to the foot result in fracture, and there is a higher chance of intra-articular involvement with neurovascular injury [ 3 ]. Another unique consideration that must be made when a foot/ankle gunshot injury occurs is whether to retrieve the bullet.…”

“…Another unique consideration that must be made when a foot/ankle gunshot injury occurs is whether to retrieve the bullet. This decision is made based on the presence of motor issues, location of the lesion, and degree/exacerbation of pain [ 3 ]. The most common types of imaging used to assess gunshot injuries are x-rays and can be escalated to total body CT if there are signs of vascular damage present [ 4 ].…”