Management of Low Velocity Gunshot-Induced Fractures

Geissler, William B.; Teasedall, Robert D.; Tomasin, J; Hughes, James L.

doi:10.1097/00005131-199003000-00007

Cited by 70 publications

(48 citation statements)

References 0 publications

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“…We excluded studies focusing on soft tissue injuries; fractures of the head, spine, hand, or foot; isolated joint injuries; associated injuries of the abdomen or chest; injuries inflicted by shotguns; and combat or high-velocity injuries. This resulted in 14 articles [3,5,10,11,15,17,22,24,27,32,34,38,39,41] fulfilling the inclusion criteria, and only four of them [10,15,17,22] were comparative studies. Of these four comparative studies, only two were prospective, randomized controlled trials, and they actually addressed different issues on the use of antibiotics in gunshot-induced fractures treated nonoperatively.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…Some of these articles [5,10,11,14,15,17,21,22,28,[32][33][34]41] did not provide information on the location of the extremity fracture, while others [10,11,14,15,17,21,32,33,41] included hand and feet fractures. Similarly, some studies [3,6,13,19,21,27,29,32,34] did not provide enough data on the type of gun used and others [3,6,13,19,21,23,26,29,33,34,38] reported mixed results; in many cases, the type of gun used could not be identified [3,13,26].…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…Dickey et al [10], in a prospective, randomized study, treated gunshot fractures nonoperatively with and without antibiotics and found similar infection rates between the two groups. However, many investigators advocate the use of antibiotics after gunshot trauma of the extremities [6,15,17,41] since it has been shown, both in vitro [36,40] and in the clinical setting [33], that most gunshot wounds are contaminated.…”

Section: Introductionmentioning

confidence: 99%

“…Shorter [1,7,10,15,17,28,30,42] versus longer [11,12,16,23,24,29,33,41] courses of antibiotics have been used. Some authors [1,6,22,24,39] advocate additional gram-negative coverage, while others [7,11,17,19,20,23,26,30,32,38,41,42] regard it as unnecessary.…”

Section: Introductionmentioning

confidence: 99%

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Antibiotics in the Treatment of Low-velocity Gunshot-induced Fractures: A Systematic Literature Review

Papasoulis

Patzakis

Zalavras

2013

Clinical Orthopaedics &Amp; Related Research

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Background Low-velocity gunshots are often associated with extremity fractures. There is no consensus, however, on the use of antibiotics for these injuries. Questions/purposes We performed a literature review to answer the following questions: (1) Are antibiotics needed for the treatment of these fractures? (2) Is gram-negative coverage necessary? (3) How long should antibiotics be administered? And (4) which is the optimal administration route? Methods We conducted a MEDLINE 1 search and found only two relevant prospective, randomized studies. Further searches identified all case series with information on the use of antibiotics in gunshot fractures. In total, 33 studies provided enough data to answer the study questions. An assessment of the quality of the identified studies was performed. Twenty-three studies met at least 1 .2 of the quality items of the assessment tool.

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Section: Search Strategy and Criteriamentioning

confidence: 99%

Section: Search Strategy and Criteriamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Antibiotics in the Treatment of Low-velocity Gunshot-induced Fractures: A Systematic Literature Review

Papasoulis

Patzakis

Zalavras

2013

Clinical Orthopaedics &Amp; Related Research

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“…Some sources suggest that bullets and bullet fragments not in contact with synovial fluid or cerebrospinal fluid cause little to no harm and can be left where they come to rest indefinitely [5,10,18]. However, modern hollow-point bullets are designed to fragment, deform, and tumble when entering a body cavity, which prevents overpenetration and The institution of one or more of the authors (AS, KC, GJH, KJK) has received, during the study period, funding from Synthes (West Chester, PA, USA).…”

Section: Introductionmentioning

confidence: 99%

Retained Bullet Removal in Civilian Pelvis and Extremity Gunshot Injuries: A Systematic Review

Riehl

Sassoon

Connolly

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Although gunshot injuries are relatively common, there is little consensus about whether retained bullets or bullet fragments should be removed routinely or only in selected circumstances. Questions/purposes We performed a systematic review of the literature to answer the following questions: (1) Is bullet and/or bullet fragment removal from gunshot injuries to the pelvis or extremities routinely indicated? And, if not, (2) what are the selected indications for removal of bullets and/or bullet fragments? Methods A search of the English-language literature on the topic of gunshot injury and bullet removal was performed using the National Library of Medicine and MEDLINE 1 and supplemented by hand searching of bibliographies of included references. Studies were included if they provided clinical data on one or both of our study questions; included studies were evaluated using the levels of evidence rubric. Most studies on the subject were expert opinion (Level V evidence), and these were excluded; one Level III study and seven Level IV studies were included.Results No studies provided a rationale for routine bullet removal in all cases. The studies identified bullet fragment removal as indicated acutely for those located within a joint, the palm, or the sole. Chronic infection, persistent pain at the bullet site, and lead intoxication were reported as late indications for bullet removal. Conclusions The evidence base for making clinical recommendations on the topic of bullet and bullet fragment removal after gunshot injury is weak. Level I and II evidence is needed to determine the indications for bullet removal after gunshot injury.

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