Jai Prakash Khatri1, Manoj Kumar2, Chander Mohan Singh3. 1. Joint Replacement Centre, Army Hospital (R&R), New Delhi, 110010, India. 2. Department of Orthopaedics, 92 Base Hospital, Srinagar, Jammu & Kashmir, 190004, India. nirvan009@gmail.com. 3. Department of Orthopaedics, AFMC, Pune, 411010, India.
Abstract
PURPOSE: High-velocity gunshot fractures are primarily a domain of military medicine. Traditionally, the management of choice for these injuries has been an external fixation. However, we present a series of high-velocity gunshot fractures of tibia managed with primary internal fixation. METHODS: Twenty-nine cases of high-velocity gunshot tibial fractures presenting within six hours of trauma were taken up for primary internal fixation and followed up at two months, four months, six months and one year including telephonic follow-up for five patients. RESULTS: Cases with various grades of open fracture were taken up for debridement and primary internal fixation within a mean period of three hours 40 minutes post trauma. Twenty-two cases were managed with unreamed interlocking nail and fixation was done with plate in seven cases. Five cases developed early superficial infection and four developed deep infection. All tibia united; however, secondary procedures were required in six cases to achieve union. One patient developed infected non-union which was managed with rail fixator. One patient was left with chronic discharging sinus. CONCLUSIONS: High-velocity gunshot wounds of leg present special challenge to the orthopaedic surgeons. Timely intervention, through debridement and meticulous soft-tissue handling, can give good results with primary internal fixation. Our results are comparable to open fractures of tibia due to other causes and with other studies using external fixation. Further randomised controlled trials are needed to substantiate our findings.
PURPOSE: High-velocity gunshot fractures are primarily a domain of military medicine. Traditionally, the management of choice for these injuries has been an external fixation. However, we present a series of high-velocity gunshot fractures of tibia managed with primary internal fixation. METHODS: Twenty-nine cases of high-velocity gunshot tibial fractures presenting within six hours of trauma were taken up for primary internal fixation and followed up at two months, four months, six months and one year including telephonic follow-up for five patients. RESULTS: Cases with various grades of open fracture were taken up for debridement and primary internal fixation within a mean period of three hours 40 minutes post trauma. Twenty-two cases were managed with unreamed interlocking nail and fixation was done with plate in seven cases. Five cases developed early superficial infection and four developed deep infection. All tibia united; however, secondary procedures were required in six cases to achieve union. One patient developed infected non-union which was managed with rail fixator. One patient was left with chronic discharging sinus. CONCLUSIONS: High-velocity gunshot wounds of leg present special challenge to the orthopaedic surgeons. Timely intervention, through debridement and meticulous soft-tissue handling, can give good results with primary internal fixation. Our results are comparable to open fractures of tibia due to other causes and with other studies using external fixation. Further randomised controlled trials are needed to substantiate our findings.
Entities:
Keywords:
Gunshot; Internal fixation; Military medicine; Open fracture; Tibia
Authors: M Held; E Engelmann; R Dunn; S S Ahmad; M Laubscher; M J B Keel; S Maqungo; S Hoppe Journal: Orthop Traumatol Surg Res Date: 2017-05-22 Impact factor: 2.256