Ballistic Fractures During The 2003 Gulf Conflict – Early Prognosis And High Complication Rate

Abstract

Ballistic fractures remain a challenge for trauma surgeons in times of war and still have a poor prognosis. Further work is required to determine the optimal treatment of these injuries during conflicts. In addition, there still seems to be a continued need to re-learn the principles of war surgery in order to minimise complications and optimise functional recovery.

Gunshot-induced fractures of the extremities: a review of antibiotic and debridement practices

“…The 58 articles included for analysis and review 39••, [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] were identified through a systematic, multi-step process. Eight hundred primary articles describing gunshot-induced fractures of the extremities or pelvis were first identified using PubMed's MeSH term database ( Fig.…”

“…Upon presentation, these fractures are typically treated according to algorithms associated with the management of open fractures to include extensive debridement and broad-spectrum antibiotic use. Principles of managing high-velocity injuries continue to be through debridement, removal of foreign bodies and devitalized tissues, irrigation, immobilization, and delayed primary closure [45][46][47][48][49][50][51][52][53][54][55][56][57]. Despite such protocols, highvelocity ballistic injuries nevertheless have a higher rate of infectious complications despite debridement and antibiotic administration.…”

“…Thirteen studies met the inclusion criteria for this review in which debridement policies of high-velocity gunshot wound (GSW) fractures were described [45][46][47][48][49][50][51][52][53][54][55][56][57]. Of these, 12 studies recommended extensive debridement for patients presenting with high-velocity GSW fractures [45][46][47][48][49][50][51][52][53][54][55][56]. These studies incorporated a protocol consisting of extensive debridement-often multiple rounds-with no study opting for superficial or no debridement.…”

“…Furthermore, all 13 studies included patients who were operatively treated for stabilization of their gunshot-induced fractures, with eight studies consisting only of patients treated by operative means [45][46][47][48][49][50][51][52]. A total of 566 fractures comprised these 13 studies, with an overall infection rate of 41.4 % (109/263) when only including those studies that provided infection rates [45][46][47][48][49][50][51][52][53][54][55][56]. This infection rate significantly differed (p=0.0001) from the overall infection rate for patients who underwent either superficial or extensive debridement for treatment of low-velocity gunshot fractures (9.5 %, 25/262) [26][27][28][29][30][31][32][33][34][35][45][46][47][48][49][50][51][52][53][54][55][56].…”

“…A total of 566 fractures comprised these 13 studies, with an overall infection rate of 41.4 % (109/263) when only including those studies that provided infection rates [45][46][47][48][49][50][51][52][53][54][55][56]. This infection rate significantly differed (p=0.0001) from the overall infection rate for patients who underwent either superficial or extensive debridement for treatment of low-velocity gunshot fractures (9.5 %, 25/262) [26][27][28][29][30][31][32][33][34][35][45][46][47][48][49][50][51][52][53][54][55][56]. This combination of immediate extensive debridement followed by delayed closure is seen with a variety of fractures caused by high-velocity fractures [45][46][47][48][49][50][51][52][53][54][55][56].…”