Characteristic Features and Outcomes of Open Gunshot Fractures of Long-bones with Gustilo Grade ۳: A Retrospective Study

Background: The incidence of gunshot injuries is growing, and civilian orthopedics should be more aware of the treatment and consequences of these injuries. This study aimed to describe the characteristic features and complications of gunshot injuries to long-bones.Methods: A total of ۵۰ patients who presented with an open gunshot fracture of the tibia, humerus, and femur in the emergency room of our hospital were included in this study. Primary irrigation and debridement, as well as prophylactic antibiotics, were administered in the emergency room. The treatment was performed either conservatively (n=۴) or surgically (n=۴۶). The external fixator, nailing, or plating was used for surgical fixation. Results: The mean age and follow-up duration of the patients were ۳۲.۳±۹.۹ years and ۱۳.۱±۵.۶ months, respectively. The most common injured long bone was the femur (۳۲ of ۵۰). Regarding the Gustilo grade, IIIa, IIIb, and IIIc were observed in ۳۷, ۷, and ۵ patients, respectively. The Masquelet technique was used for ۷ (۱۴%) patients, and ۱۲ (۲۴%) cases had skin flaps. Furthermore, the vascular injury was present in ۵ (۱۰%) patients, and Malunion of the fracture site was observed in ۵ (۱۰%) cases. Nonunion of the fractured bone occurred in ۱۳ (۲۶%) patients that was significantly associated with the presence of vascular injuries (P=۰.۰۲). Postoperative infection occurred in ۹ (۱۸%) patients and was significantly associated with the presence of skin flap (P=۰.۰۱۴). Conclusion: Gunshot injuries of long bones are associated with a high incidence of post-treatment complications, such as infection and nonunion, and therefore, more intensive care should be taken to avoid these complications.Level of evidence: III

Keywords:

Gunshot injury , Gustilo classification , Infection , nonunion