Gunshot Fractures of the Forearm: A Multicenter Evaluation

Veltre, David R.; Tornetta, Paul; Krause, Peter C.; George, Mary P.; Vallier, Heather A.; Nguyen, Mai P.; Reich, Michael S.; Cannada, Lisa K.; Eng, Michael; Miller, Anna N.; Goodwin, A.I.; Mir, Hassan R.; Clark, Charles B.; Sandberg, Ben; Westberg, Jerald R.; Mullis, Brian; Behrens, Jonathan; Firoozabadi, Reza

doi:10.1097/bot.0000000000002056

Cited by 8 publications

(5 citation statements)

References 35 publications

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“…Among group A studies, the incidence of nerve injury was 32% (138/ 438) in studies that exclusively evaluated patients presenting with ballistic fractures 20,[22][23][24]26,32 . In studies that included all patients with GSWs to the UE (with or without fracture), the rate of nerve injury was 26% (431/ 1,661) [17][18][19]21,25,[27][28][29][30][31] .…”

Section: Epidemiologymentioning

confidence: 99%

“…In patients sustaining a GSW to the UE (group A), we found the incidence of UE nerve injury to be 27% (569/2,099) [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] (Table I). This rate is similar to our previously published experience, with approximately 30% of patients sustaining a nerve injury after a gunshot to the UE 29 .…”

Section: Epidemiologymentioning

confidence: 99%

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Upper Extremity Ballistic Nerve Injury

Wolf,

Chen,

Strelzow

et al. 2024

JBJS Reviews

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» Gunshot injuries to the upper extremity (UE) have high likelihood for causing peripheral nerve injury secondary to the high density of vital structures. Roughly one-fourth of patients sustaining a gunshot wound (GSW) to the UE incur a nerve injury. Of these nerve injuries, just over half are neurapraxic. In cases of surgical exploration of UE nerve injuries, nearly one-third demonstrate a transected or discontinuous nerve.» Existing literature regarding surgical management of nerve injuries secondary to GSWs comes from both military and civilian injuries. Outcomes are inconsistently reported, and indications are heterogeneous; however, reasonable results can be obtained with nerve reconstruction.» Our proposed management algorithm hinges on 4 treatment questions: if there is a nerve deficit present on examination, if there is a concomitant injury in the extremity (i.e., fracture or vascular insult), whether the injured nerve would be in the operative field of the concomitant injury, and whether there was an identified nerve lesion encountered at the time of surgery by another surgeon?» Early exploration rather than continued expectant management may offer improved recovery from GSW nerve injuries in particular situations. When an UE nerve deficit is present, establishing follow-up after the initial GSW encounter and early referral to a peripheral nerve surgeon are pivotal.

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Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Upper Extremity Ballistic Nerve Injury

Wolf,

Chen,

Strelzow

et al. 2024

JBJS Reviews

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“…As Shu et al [11] collisions, pedestrian-involved vehicle collisions, falls from a height, and injuries from firearms. In addition, the incidence of firearm-associated extremity injuries, including those that involve the forearm, has increased during the past decade [9,12]. Understanding the nature and nuances of these more-severe injury patterns will help us treat not only the fracture but also the soft tissue and other associated injuries, and future studies need to be attentive to these evolving concerns.…”

Section: Mai P Nguyen MDmentioning

confidence: 99%

“…Updated, contemporary studies are needed on high-energy fractures. For example, Veltre et al [12] recently found that fractures of the forearm owing to gunshots are associated with a high likelihood of infection and nonunion. We can gain a better understanding of the sequelae and outcomes of delayed wound closures over forearm fixation by performing long-term observational studies on the infection rate, functional outcomes, and union rate for this injury.…”

Section: How Do We Get There?mentioning

confidence: 99%

CORR Insights®: What Factors Are Associated With Delayed Wound Closure in Open Reduction and Internal Fixation of Adult Both-bone Forearm Fractures?

Nguyen

2023

Clin Orthop Relat Res

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“…There is no current standard of care regarding antibiotic use for extremity GSWs, both for GSWs treated operatively and for those treated nonoperatively [6][7][8][9]. To address the risk of infection after GSW injury, most studies recommend that such injuries be treated with some form of antibiotics; this is reflected in the high rates of antibiotic use after extremity GSWs, which range from 88% to 91% [10,11]. However, there remain large variations in the type and number of antibiotics selected, as well as in dosing and duration.…”

Section: Introductionmentioning

confidence: 99%

Single-Dose First-Generation Cephalosporin for Extremity Gunshot Wounds Offers Sufficient Infection Prophylaxis

Bijwadia,

Flagstad,

Sinkler

et al. 2024

Trauma Care

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Antibiotic prophylaxis for extremity gunshot wounds (GSWs) is highly variable. The objective of the present study is to quantify the adherence rate to a protocol for single-dose cephalosporin prophylaxis for extremity GSWs and the impacts on post-injury infection rates. We reviewed patients presenting to a level 1 trauma center with an extremity gunshot wound between 2019 and 2021. Infection rates were compared for patients following the protocol or not, and for patients presenting before or after the protocol’s implementation. Overall, 94% of patients received antibiotic treatment at presentation, but only 34% followed the single-dose antibiotic protocol. The rate of protocol adherence increased from 15% to 39% after the protocol was implemented in the hospital in January 2020 (p = 0.081). Infection rates were not different before and after the protocol implementation (25% vs. 18%, p = 0.45). Infection rates were also not different between patients who did and did not follow the protocol (15% vs. 20%, p = 0.52). The implementation of a single-dose cephalosporin protocol increased adherence to the protocol in a level 1 trauma center without increasing infection rates. These findings support conservative treatment along with a single dose of first-generation cephalosporin antibiotic for uncomplicated extremity GSWs in order to decrease healthcare costs without compromising infection risk.

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Gunshot Fractures of the Forearm: A Multicenter Evaluation

Cited by 8 publications

References 35 publications

Upper Extremity Ballistic Nerve Injury

Upper Extremity Ballistic Nerve Injury

CORR Insights®: What Factors Are Associated With Delayed Wound Closure in Open Reduction and Internal Fixation of Adult Both-bone Forearm Fractures?

Single-Dose First-Generation Cephalosporin for Extremity Gunshot Wounds Offers Sufficient Infection Prophylaxis

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