Gunshot Femoral Fractures with Vascular Injury: A Retrospective Analysis

Rehman, Saqib; Salari, Nima; Codjoe, Paul; Rehman, Mahin; Gaughan, John

doi:10.1111/j.1757-7861.2012.00186.x

Cited by 5 publications

(5 citation statements)

References 17 publications

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“…Several investigations at the authors' institution have concluded that either approach is acceptable in the appropriate patient, and that an early discussion between the vascular and orthopedic teams facilitates the best outcome. 36,37 If the vascular team anticipates the need for stabilized length and the orthopedic procedure can be completed quickly, the orthopedic team may proceed. On the other hand, if limb ischemia appears to be threatening the limb, the vascular repair should take priority.…”

Section: Vascular Injurymentioning

confidence: 99%

Surgical Management Principles of Gunshot-Related Fractures

Tosti¹,

Rehman²

2013

Orthopedic Clinics of North America

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Section: Vascular Injurymentioning

confidence: 99%

Surgical Management Principles of Gunshot-Related Fractures

Tosti¹,

Rehman²

2013

Orthopedic Clinics of North America

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“…47 Although it is a common practice to proceed directly with vascular repair initially, some studies have challenged this notion and showed that temporary intravascular shunts may improve patient morbidity and decrease the risk of compartment syndrome. 5 In a study of 24 patients with ballistic femur fractures and an associated vascular injury, Rehman et al 48 showed that surgical sequence did not seem to affect the outcome regarding limb loss, compartment syndrome, or mortality. They did find, however, that orthopaedic intervention after revascularization is a risk for disruption of the vascular repair.…”

Section: Discussionmentioning

confidence: 99%

Assessment and Interventions for Vascular Injuries Associated With Fractures

Spitler

Patch

McFarland

et al. 2022

J Am Acad Orthop Surg

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Vascular injuries associated with fractures are limb-threatening injuries with notable morbidity. The prompt and thorough evaluation of these patients is imperative to diagnose vascular injuries, and coordinated multidisciplinary care is needed to provide optimal outcomes. The initial assessment includes a detailed physical examination assessing for hard and soft signs of arterial injury, and the arterial pressure index can be used to reliably identify vascular compromise and the need for additional assessment or intervention. Advanced imaging in the form of CT angiography is highly sensitive in additional characterization of the potential injury and can be obtained in an expedient manner. The optimal treatment of fractures with vascular injuries includes providing skeletal stability and confirming or reestablishing adequate distal perfusion as soon as possible. Options for vascular intervention include observation, ligation, direct arterial repair, vascular bypass grafting, endovascular intervention, and staged temporary shunting, followed by bypass grafting. Although the optimal sequence of surgical intervention remains an incompletely answered question, the orthopaedic role in the care of patients with these injuries is to provide mechanical stability to the injured limb to protect the vascular repair and surrounding soft-tissue envelope.

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“…The use of a tourniquet will compromise the collateral perfusion that is likely responsible for continued distal perfusion in cases of major arterial injury [28]. The surgical sequence of events, "fracture first" or "vascular first, " is somewhat controversial [29][30][31]. We prefer to proceed with rapid external fixation prior to vascular repair to protect future repair.…”

Section: A a B B C C D D E Ementioning

confidence: 99%

Management of gunshot wounds near the elbow: experiences at a high-volume level I trauma center

Ghilzai,

Ghali,

Singh

et al. 2024

Clin Shoulder Elb

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Background: Gunshot-related fractures near the elbow are challenging, and available data to guide the practitioner are lacking. This report analyzes injury patterns and treatment strategies in a case series from a high-volume urban trauma center.Methods: All periarticular gunshot fractures near the elbow treated at a level 1 trauma center from 2014 to 2018 were retrospectively reviewed. Fracture location, patient demographics, concomitant injuries, treatment modalities, and complications were analyzed.Results: Twenty-four patients were identified. All patients received prophylactic antibiotics upon admission and underwent urgent surgical debridement. Open reduction and internal fixation (ORIF) was performed with initial debridement in 22 of 24 patients. Seven patients sustained distal humerus fractures, 10 patients sustained isolated proximal ulna or proximal radius fractures, and seven had combined fracture patterns. Eleven patients presented with nerve palsy, and two had transected nerves. Two patients had vascular injury requiring repair. One patient required a temporary elbow-spanning external fixator and underwent staged debridement followed by ORIF. One patient with a grade IIIC fracture developed a deep infection that precluded ORIF. One patient required revision ORIF due to fracture displacement.Conclusions: This investigation reports on management of ballistic fractures near the elbow at a busy urban level I trauma center. Our management centered on rapid debridement, early definitive fixation, and intravenous antibiotic administration. We report on associated neurovascular injury, bone loss, and other challenges in this patient population.Level of evidence: IV.

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Gunshot Femoral Fractures with Vascular Injury: A Retrospective Analysis

Cited by 5 publications

References 17 publications

Surgical Management Principles of Gunshot-Related Fractures

Surgical Management Principles of Gunshot-Related Fractures

Assessment and Interventions for Vascular Injuries Associated With Fractures

Management of gunshot wounds near the elbow: experiences at a high-volume level I trauma center

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