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

Abstract

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.

Bullet to the femoral head

“…Neural and vascular injuries are primary determinants of both mortality and long-term outcomes in these patients. [4][5][6] Extremity vascular injury and subsequent hemorrhage can induce hemodynamic instability and impact extremity viability. Fascial layer separation plays a central role in the pattern of injury due to the kinetic energy transfer involved in the immediate occurrence of the distal injury and late development of compartment syndrome.…”

Retained Bullet Removal in Civilian Pelvis and Extremity Gunshot Injuries: A Systematic Review

“…And, if not, (2) what are the selected indications for removal of bullets and/or bullet fragments? This systematic review was limited by a literature that consisted predominantly of Level IV evidence (retrospective case series); there was only a single study [30] that included a control group (Level III evidence). Due to the lack of high-level evidence available in the literature pertaining to the primary research questions, any treatment recommendations based on this literature must be made with caution.…”

“…However, expert opinion has listed high-energy injuries as an indication for bullet removal [23]. Finally, there is some evidence, though the numbers are small, that a bullet that penetrates a hollow viscus before causing orthopaedic injury does not necessarily need to be removed [22,30].…”

“…Of those, 48 were Level V evidence, reducing the count to seven studies; hand searching the bibliographies of these yielded one additional study. The final number of studies included in this review therefore was eight, including seven Level IV studies (case series) [1,2,11,15,19,22,28] and one Level III study (retrospective study with a control group) [30] (Table 1).…”

“…Existing Level III evidence pertaining to bullet fragment removal consisted of one article, which looked at subsequent infection as its main outcome measure. Watters et al [30] reported on 47 patients with pelvic gunshot injuries. The incidence of infection was determined for patients with retained bullets or bullet fragments and for those in whom bullet fragments had exited the body or been surgically removed.…”