Low-velocity gunshot fractures of the tibia

Crainz, Edoardo; Gambera, Dario; Maniscalco, Pietro; Bertone, Celeste; Rivera, Fabrizio; Maggiore, Domenico

doi:10.1007/s007760200064

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…Therefore, the surgeon should 'treat the wound, not the weapon'. 5,14 This also creates controversy around the appropriate classification to use in these fractures. Gustilo and Anderson in their original article describe a 'special category' within grade 3 fractures for gunshot injuries, with no mention of them falling into grades 1 or 2.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the wide variety of GSW injury patterns, treatment plans must be personalised; therefore no single protocol can be established. 5 In an attempt to minimise prosthetic infection and facilitate soft tissue management, these injuries traditionally have been treated with external fixation devices. 5 This approach protects the remaining blood supply, stabilises the bone, and allows easy access for wound care, with low infection rates.…”

Section: Introductionmentioning

confidence: 99%

“…5 In an attempt to minimise prosthetic infection and facilitate soft tissue management, these injuries traditionally have been treated with external fixation devices. 5 This approach protects the remaining blood supply, stabilises the bone, and allows easy access for wound care, with low infection rates. 6 External fixation, however, can present issues with alignment, time to union and high rates of pin tract infection and loosening when used for extended periods.…”

Section: Introductionmentioning

confidence: 99%

“…7 GSWs also have a poor correlation between external wound size and the extent of the underlying tissue damage, making predictions concerning infection and union difficult. 5,8,9 Intramedullary (IM) nailing is considered a viable option in treating these injuries as it provides good access to soft tissues without bulky external hardware, allows early range of motion of the knee and ankle, and causes minimal soft tissue stripping at the fracture site. [10][11][12] Given the differing opinions on how best to treat GSWs of the tibia, this study reviewed the results of all patients treated with IM nailing of GSW tibia fractures at our tertiary care facility.…”

Section: Introductionmentioning

confidence: 99%

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Gunshot tibia fractures treated with intramedullary nailing: A single centre retrospective review

Hilton

Kruger

Wiese³

et al. 2017

SA orthop. j.

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Background: Open tibia fractures are notoriously difficult to treat, with a high rate of union problems and infection. Gunshot wound-associated fractures of the tibia compound these issues further by causing extensive bone comminution and soft tissue damage. No universally accepted management protocol exists, but intramedullary (IM) nailing of these injuries is an attractive treatment strategy. It provides stable internal fixation and limits further insult to the soft tissue envelope. It also allows complete access for wound management and early range of movement of the adjacent joints. This study aims to review the results of patients treated with IM nailing for gunshot wound (GSW) tibia fractures to assess whether this is a viable treatment option for this injury.Methods: A retrospective folder review was performed of all adult patients who sustained a GSW tibia fracture treated with intramedullary nailing between January 2009 and December 2014. Parameters evaluated included time to theatre, time to wound closure, radiographic extent of fracture comminution, anatomical alignment, time to union and incidence of chronic osteomyelitis.Results: Twenty-two patients were eligible for inclusion; however, nine were lost to follow-up. The remaining 13 patients achieved union over an average of 26 weeks. Three cases developed osteomyelitis, all of which had radiographic zones of comminution exceeding 120 mm. No cases of malunion were reported and no other significant trends noted.Conclusion: Treatment of tibial gunshot fractures must be individualised according to both the soft tissue injury and radiographic zone of comminution in order to achieve a favourable outcome. Intramedullary nailing is an effective treatment strategy for low Gustilo-Anderson grade injuries, with minimal complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Gunshot tibia fractures treated with intramedullary nailing: A single centre retrospective review

Hilton

Kruger

Wiese³

et al. 2017

SA orthop. j.

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The Role of Débridement in Low-Velocity Civilian Gunshot Injuries Resulting in Pelvis Fractures: A Retrospective Review of Acute Infection and Inpatient Mortality

Watters

Anglen

Mullis³

2011

Journal of Orthopaedic Trauma

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There was no increased incidence of infection in the absence of aggressive surgical débridement of pelvis GSI wounds. The study also demonstrated that retained bullets and bullet fragments did not increase the risk of infection, even after penetrating the GI tract organs. Finally, this study suggests there may be an increased risk of infection related to pelvis GSIs compared with reported infection rates related to GSIs of the extremities, likely secondary to a high rate of concomitant GI injuries associated with pelvis GSIs; however, there was no incidence of osteomyelitis.

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Gunshot-associated Fractures in Children and Adolescents Treated at Two Level 1 Pediatric Trauma Centers

Naranje

Gilbert

Stewart

et al. 2016

Journal of Pediatric Orthopaedics

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Low-velocity gunshot fractures of the tibia

Cited by 4 publications

References 21 publications

Gunshot tibia fractures treated with intramedullary nailing: A single centre retrospective review

Gunshot tibia fractures treated with intramedullary nailing: A single centre retrospective review

The Role of Débridement in Low-Velocity Civilian Gunshot Injuries Resulting in Pelvis Fractures: A Retrospective Review of Acute Infection and Inpatient Mortality

Gunshot-associated Fractures in Children and Adolescents Treated at Two Level 1 Pediatric Trauma Centers

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