Functional Outcomes After Gunshot Wounds to the Foot and Ankle

Husain, Zeeshan S.; Schmid, Stephen; Lombardo, N.J.

doi:10.1053/j.jfas.2015.06.004

Cited by 11 publications

(7 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Husain et al 29 reported a small number of hindfoot fractures in their series. Although statistical analysis was limited, they observed worse outcomes with intra-articular involvement than without.…”

Section: Fracture Managementmentioning

confidence: 91%

“…Although data on the management of foot fractures from gunshot wounds are limited, Husain et al 29 describe their experience with 27 patients with unilateral GSIs to the foot, including 26 out of 27 patients (96%) with an associated fracture. They developed a classification system that divided the foot into 2 zones: zone 1 (distal to the midtarsal joints) and zone 2 (proximal to the midtarsal joints, including the midfoot).…”

Section: Fracture Managementmentioning

confidence: 99%

“…Husain et al 29 noted that patients with zone 2B injuries had clinically significant limitations after treatment, including 40% who required secondary surgery for arthrodesis after initial attempts at joint preservation. The authors concluded that optimal treatment for zone 2B fractures should be primary arthrodesis after debridement and infection management.…”

Section: Midfootmentioning

confidence: 99%

See 2 more Smart Citations

Gunshot-Related Injuries to the Foot & Ankle: Review Article

et al. 2020

View full text Add to dashboard Cite

Gunshot-related injuries remain a significant and important cause of global morbidity and cost. The foot and ankle has certain anatomic and functional considerations that make gunshot-related injuries challenging to manage. While the scientific literature regarding gunshot-related injuries is extensive, little of the existing literature focuses on the foot and ankle. While principles of management can be somewhat extrapolated from the current literature, an understanding of the body of work specific to the foot and ankle is valuable. Therefore, this review provides an overview of ballistic injuries to the foot and ankle as well as specific guidelines to aid surgeons in treating these difficult injuries. Level of Evidence: Level V, expert opinion.

show abstract

Section: Fracture Managementmentioning

confidence: 91%

Section: Fracture Managementmentioning

confidence: 99%

Section: Midfootmentioning

confidence: 99%

See 1 more Smart Citation

Gunshot-Related Injuries to the Foot & Ankle: Review Article

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Bullets retained in the tibiotalar and subtalar intra-articular region should be removed, and ankle arthroscopy has been demonstrated as an option for bullet retrieval and osteochondral fragment repair at the tibiotalar joint 44,56 . Despite a historic concern for increased infection risk associated with shoe puncture wounds, GSWs to the foot do not appear to have an increased risk of pseudomonal infection 105 . 106 , grade A indicates good evidence (Level-I studies with consistent findings) for or against recommending intervention; grade B, fair evidence (Level-II or III studies with consistent findings) for or against recommending intervention; grade C, poor-quality evidence (Level-IV or V studies with consistent findings) for or against recommending intervention; and grade I, insufficient or conflicting evidence not allowing a recommendation for or against intervention.…”

Section: Foot and Anklementioning

confidence: 99%

“…Removal should be considered when they are superficial 104 . Injuries distal to the midtarsal joint have the best functional outcomes, while injuries proximal to this junction are associated with more comminution and soft-tissue damage 105 . Bullets retained in the tibiotalar and subtalar intra-articular region should be removed, and ankle arthroscopy has been demonstrated as an option for bullet retrieval and osteochondral fragment repair at the tibiotalar joint 44,56 .…”

Section: Foot and Anklementioning

confidence: 99%

Management of Civilian Low-Velocity Gunshot Injuries to an Extremity

Jabara

Gannon

Vallier

et al. 2021

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

ä Despite an increasing rate of civilian low-velocity gunshot injuries, there remains a lack of evidence-based treatment standards.ä Most low-velocity gunshot-induced fractures of the extremity can be managed similarly to non-gunshot-induced fractures, with the goals of restoring function and minimizing complications.ä There are a limited number of high-quality studies to support the use of prophylactic antibiotics for nonoperatively treated gunshot wounds.ä Intra-articular retained bullets should be removed, while prophylactic irrigation and debridement for a transarticular bullet is not routinely warranted for infection prevention.ä Much of the literature on low-velocity gunshot wounds is Level-III or IV evidence, warranting the need for higherpowered, randomized, prospective investigations.Gun violence and firearm injuries are serious public health problems in the United States. Civilian gunshot wounds (GSWs) are associated with substantial morbidity, mortality, and socioeconomic consequences. The incidence of nonfatal GSWs continues to increase in the United States, with an estimated 535,150 nonfatal GSWs between 2014 to 2018, increasing approximately 41% over the previous 5 years 1 . GSWs have increased from eighth to sixth among the most common causes of nonfatal violence-related emergency department visits 1 . Nonfatal GSWs disproportionately impact males, members of racial and/or ethnic minorities, and those under the age of 35 years 2 . Urban areas remain the predominant center of injury, with most gun violence concentrated among high-risk populations 3 . These injuries have profound economic impact, with the cost of care in the U.S. exceeding $2.7 billion annually 4 .The military experience has provided the basis for highvelocity GSW management. However, most GSWs presenting to civilian medical facilities are caused by low-velocity handguns 5 . Despite the increasing frequency of civilian GSWs, the management of these injuries is debated 4,[6][7][8][9] . The present review focuses on the current best evidence on the management of low-velocity GSWs to an extremity in the civilian population. GSWs to the spine and high-velocity GSWs are not discussed. Historical Perspective and BallisticsPrior to the 17th century, bacteria were unknown and infection from GSWs was thought to be secondary to gunpowder poisoning. During that era, standard of care was bullet removal and cautery 10 . Although wartime data have provided foundational principles for the treatment of high-velocity GSWs, there are distinct differences in the management of civilian lowvelocity GSWs. By definition, low-velocity bullets travel <2,000 ft/s (610 m/s) (while high-velocity bullets travel >2,000 ft/s). Bullet properties (mass and shape), travel characteristics (yaw, tumble, and velocity), impact characteristics (pass-through Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article...

show abstract

Impact of injury mechanism on early wound closure in patients with acute conflict‐related extremity wounds: A prospective cohort analysis from two civilian hospitals in Iraq and Jordan

Haque,

Haweizy,

Bashaireh

et al. 2024

World j. surg.

View full text Add to dashboard Cite

BackgroundGunshots and bomb blasts are important causes of extremity injuries in conflict zones, yet little research exists on the characteristics and outcomes of these injuries in civilian populations.MethodsWe performed a prospective cohort analysis utilizing data from a randomized trial conducted at two civilian hospitals in Jordan and Iraq in 2015–2019. Adults who presented ≤72 h of sustaining an extremity injury were included. We used mechanism of injury (gunshot/bomb blast) as the exposure and wound closure by day 5 as the primary outcome measure.ResultsThe population predominantly comprised young men (n = 163, 94% male, and median age 29 years) injured by gunshots (61%) or bomb blasts (39%). Compared with the gunshot group, more participants in the bomb blast group had concomitant injuries (32/63 [51%] vs. 11/100 [11%], p < 0.001) and vascular injuries (9/63 [14%] vs. 4/100 [4%], p = 0.02). The wounds were larger in the bomb blast group compared with the gunshot group (median area 86 cm2 [IQR 24–161] vs. 21 cm2 [IQR 7–57], p < 0.001). Compared with the bomb blast group, significantly more participants in the gunshot group achieved wound closure by day 5 (74/100 [74%] vs. 16/63 [25%], p < 0.001). This difference remained after controlling for confounding factors (odds ratio 4.7, 95% confidence interval 1.6–13.7).ConclusionsIn civilians with conflict‐related extremity injuries, bomb blast wounds had a lower likelihood of achieving closure within 5 days than gunshot wounds, independent of other factors, such as wound size and vascular injuries.Trial RegistrationClinicalTrials.gov, NCT02444598. Registered 14‐05‐2015, https://classic.clinicaltrials.gov/ct2/show/NCT02444598.

show abstract

Functional Outcomes After Gunshot Wounds to the Foot and Ankle

Cited by 11 publications

References 26 publications

Gunshot-Related Injuries to the Foot & Ankle: Review Article

Gunshot-Related Injuries to the Foot & Ankle: Review Article

Management of Civilian Low-Velocity Gunshot Injuries to an Extremity

Impact of injury mechanism on early wound closure in patients with acute conflict‐related extremity wounds: A prospective cohort analysis from two civilian hospitals in Iraq and Jordan

Contact Info

Product

Resources

About