Management of gunshot wound-related hip injuries: A systematic review of the current literature

Tisnovsky, Ilene; S, Katz; Pincay, Jorge I.; Reinoso, Lucas Garcia; Redfern, James; Pascal, Scott C.; Wham, Bradley C.; Naziri, Qais; Suneja, Nishant

doi:10.1016/j.jor.2020.12.029

Cited by 9 publications

(8 citation statements)

References 39 publications

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“…The consensus in the limited literature, including a recent systematic review, is that hip arthroscopy may provide an efficient way to remove bullet fragments while limiting complications. 12 This study was able to report outcomes of several arthroscopically managed GSWs from a single hospital facility for the first time. Previous studies have not been able to analyze the outcomes of arthroscopic surgeries for the treatment of GSWs with as many patients from a single institution.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopy Should be Used With Caution for Gunshot Wounds to the Hip

Mullis

Figueras

Trotter

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To evaluate the safety and efficacy of hip arthroscopy immediately following gunshot wound (GSW) to the hip. Methods: Patients who received hip arthroscopy for GSWs from 2006 to 2020 by 2 surgeons at a level I trauma center were identified by Current Procedural Terminology codes. Inclusion criteria were those patients who suffered a GSW to the hip, received hip arthroscopy for treatment, and had a minimum follow-up of 2 months. The exclusion criteria were any patients younger than 18 years of age. Medical records were reviewed for patient demographics, surgical details, clinical outcomes, and complications. Results: A total of 50 hip arthroscopy cases were identified by Current Procedural Terminology codes. Of the 50 cases identified, 8 patients met the inclusion criteria. All 8 patients were male, African-American, and the mean age was 31 years (range, 19-54 years) with mean follow-up of 14 months. Five of 8 cases were noted to have poor visualization with arthroscopy. Common reasons for poor visualization were difficult access to the bullet fragments, morbid obesity, hematoma formation, and pre-existing arthritis. Of these 5 cases, 2 were converted to open procedures to retrieve the remaining bullet fragments. One patient developed abdominal compartment syndrome, most likely due to increased pulse pressure over a prolonged operative period and involvement of the acetabular fovea. Emergent exploratory laparotomy and abdominal compartment fluid release were performed, and the patient had an otherwise unremarkable hospital course. Conclusions: There are risks with the use of arthroscopic methods to remove GSW fragments, which may be greater than elective hip arthroscopy. Certain factors, such as the surgeon's arthroscopic experience, locations of bullets fragments, visual quality, length of procedure, and concomitant acetabular fractures, must be considered before proceeding with arthroscopy. Level of Evidence: Therapeutic case series.G unshot wounds (GSWs) to the hip are uncommon, typically causing articular damage and shrapnel retained within the joint. If not removed, these fragments subject the patient to an increased risk of arthritis secondary to third-body wear, chondrotoxicity from metal particles, and mechanical pain. 1 Open arthrotomy for shrapnel removal has been the procedure of choice for many years, but in 1998

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Section: Discussionmentioning

confidence: 99%

Arthroscopy Should be Used With Caution for Gunshot Wounds to the Hip

Mullis

Figueras

Trotter

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…[6] However, there is no consensus in the literature regarding the duration of antibiotic use, and there are studies recommending it to be used between 48-120 hours. [13] Antibiotics were used in all patients for the first three days. Depending on the condition of the wound, first-generation cephalosporin and aminoglycoside as a dual antibiotic, or metronidazole as a third antibiotic were added to the antibiotherapy of the patients with contaminated wounds.…”

Section: Discussionmentioning

confidence: 99%

“…It was found that removing the dead tissues by performing serial debridements on devitalized tissues significantly reduced the infection. [11,13,14,19] In our patients, both internal and external fixation were applied according to the general condition, hemodynamics, type of injury in the extremity and the general condition of the patient. Permanent fixation was performed after adequate debridement in patients with adequate soft tissue coverage.…”

Section: Discussionmentioning

confidence: 99%

Ateşli Silah Yaralanmalarında İlk Müdahale ve Komplikasyonların Yönetimi

Tokyay

Güven

Özkan

et al. 2021

Journal of Contemporary Medicine

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Amaç: Ateşli silah yaralanmaları sonucu ekstremitede yumuşak doku, nörovasküler yaralanmalar ve kemik kırıkları görülmektedir. Bu yaralanmaların şiddete yönelik olması ve adli olayların gençlerde daha sık görülmesi tedaviyi daha da zorlaştırmaktadır. Bu çalışmadaki amacımız, ateşli silahlarla ilişkili ekstremite yaralanmalarında nörovasküler, yumuşak doku yaralanmaları ve kemik kırıklarına aşamalı bir yaklaşımın nihai tedavi sonuçlarına etkisini değerlendirmektir. Gereç ve Yöntem: Bu çalışmada 2015-2020 yılları arasında ateşli silahla ilişkili ekstremite yaralanması olan ve cerrahi tedavi uygulanan 18 yaş üstü hastalar retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, yaralanma bölgeleri, eşlik eden nörovasküler yaralanmalar, ilk müdalede yapılanlar, son tedavi sonuçları, gelişen komplikasyonlar ve komplikasyonların yönetimi değerlendirildi. Bulgular: Çalışmaya katılan 54 hastanın (52 erkek, 2 kadın) yaş ortalaması 28.3 (yaş aralığı 19-61) idi. Otuz iki (%59.2)’si alt ekstremite, 22 (%40.7)’si üst ekstremite ve 5 (%9.2)’i hem alt hem üst ekstremite yaralanması tespit edildi. Üç (%5.5) hastada damar yaralanması, 3 (%5.5) hastada amputasyon ve 6 (%11.1) hastada sinir yaralanması tespit edildi. Altı hastanın beşine (%9,2) fasyotomi uygulandı. En sık karşılaşılan komplikasyon olarak 7 (%12,9) hastada eklem hareket açıklığı kaybıydı. Sonuç: Ateşli silah yaralanmalarında multidisipliner ve hasar kontrollü bir yaklaşımla erken dönemde antibiyoterapi, kemik tespiti ve seri debridmanlar sonrası nihai tedaviye geçilmesi tedavi başarısını olumlu yönde etkilemektedir. Anahtar Kelimeler: Ateşli silah yaralanmaları, Nörovasküler yaralanma, Fasiatomi, Komplikasyonlar.

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“…151 Numerous techniques have been described to remove bullets in the hip and pelvis region including arthroplasty, arthroscopy, and arthrotomy with or without surgical dislocation. 126,127,137,145,[152][153][154][155][156][157][158] Yet, no single approach seems to be superior for all cases. Sacroiliac joint involvement make extraction difficult, as arthroscopy and arthrotomy cannot successfully access the joint, yet a percutaneous minimally invasive removal has been successfully performed in this location.…”

Section: Lower Extremity Injury Hip/pelvismentioning

confidence: 99%

Gunshot Wounds: Ballistics, Pathology, and Treatment Recommendations, with a Focus on Retained Bullets

Baum¹,

Baum²,

Hayward³

2022

ORR

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As the epidemic of gunshot injuries and firearm fatalities continues to proliferate in the United States, knowledge regarding gunshot wound (GSW) injury and management is increasingly relevant to health-care providers. Unfortunately, existing guidelines are largely outdated, written in a time that high-velocity weapons and deforming bullets were chiefly restricted to military use. Advances in firearm technology and increased accessibility of military grade firearms to civilians has exacerbated the nature of domestic GSW injury and complicated clinical decision-making, as these weapons are associated with increased tissue damage and often result in retained bullets. Currently, there is a lack of literature addressing recent advances in the field of projectile-related trauma, specifically injuries with retained bullets. This review aims to aggregate the available yet dispersed findings regarding ballistics, GSW etiology, and treatment, particularly for cases involving retained projectiles.

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Management of gunshot wound-related hip injuries: A systematic review of the current literature

Cited by 9 publications

References 39 publications

Arthroscopy Should be Used With Caution for Gunshot Wounds to the Hip

Arthroscopy Should be Used With Caution for Gunshot Wounds to the Hip

Ateşli Silah Yaralanmalarında İlk Müdahale ve Komplikasyonların Yönetimi

Gunshot Wounds: Ballistics, Pathology, and Treatment Recommendations, with a Focus on Retained Bullets

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