Management of upper extremity war injuries in the subacute period: A review of 62 cases

Sari, Abdulkadir; Özçelık, İsmail Bülent; Bayirli, Derya Turan; Ayık, Ömer; Mert, Murat; Erçin, Burak Sercan; Baki, Humam; Mersa, Berkan

doi:10.1016/j.injury.2020.08.028

Cited by 7 publications

(7 citation statements)

References 49 publications

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“…Gunshot injuries should be treated as a separate clinical entity from open humerus fractures caused by other mechanisms [4]. The treatment options for various gunshot fractures range from non-operative to primary internal fixation [5].…”

Section: Discussionmentioning

confidence: 99%

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High Velocity Gunshot Fractures of Humerus: Results of Primary Plate Osteosynthesis

Kumar¹,

Khatri²,

Singh

2020

IJOO

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Background High velocity gunshot fractures usually seen in conflict zones, often mandate external fixation due to delayed presentation and associated contamination. In the presented observational study, we managed high velocity gunshot fractures of humerus with adequate debridement and primary plate osteosynthesis under controlled conditions with gratifying results. Material and Methods Eighteen consecutive cases of fracture of the humerus secondary to high velocity gunshot wounds with ages ranging from 28 to 45 years reporting within 6 h of the initial injury formed our study group. Immediate debridement, lavage and primary plate osteosynthesis was carried out following hemodynamic stabilisation and intravenous antibiotics. All the cases were followed up at 2, 4, 6 months, 1 year and then annual follow-up including telephonic follow-up for six patients. Results Fifteen cases of Gustillo Anderson type III A, two of type III B and one of type III C were managed with primary plate osteosynthesis. Brachial artery injury was addressed immediately, however injured radial nerve ends were tagged. Five cases showed delayed/non-union and were managed with decortication and autologous bone grafting. Two cases of deep infection could be managed with implant retention till union. The implants were removed following fracture consolidation. All the fractures united and no patient was left with sequelae of chronic infection. Conclusion Timely presentation of high velocity gunshot fractures of humerus teamed up with adequate debridement, soft tissue management and primary plate osteosynthesis can offer satisfactory outcomes. Associated vascular injury needs immediate attention. Nerve injuries can be addressed in a staged procedure. Our results have been satisfactory and add to the scant literature available on the subject, however further studies are warranted.

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Section: Discussionmentioning

confidence: 99%

“…Our protocol included intravenous metronidazole for anaerobic cover apart from third generation cephalosporin and aminoglycoside for 72 h postoperatively. Antibiotic with anti-psudomonal activity has been recommended for war injuries [4]. Oral Linezolid has been used in our study in cases of infection.…”

Section: Discussionmentioning

confidence: 99%

High Velocity Gunshot Fractures of Humerus: Results of Primary Plate Osteosynthesis

Kumar¹,

Khatri²,

Singh

2020

IJOO

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“…Clinical assessment of nerve tissue consistency at 3 months post-injury, using intraoperative nerve electrodiagnostic monitoring, can help make a decision as to the reconstructive needs. At this stage, nerve transfers may be considered, to address the functional deficit outside the zone of injury (Sari et al., 2020).…”

Section: Treatment Of High Energy Gunshot Wounds Of the Hand And Wristmentioning

confidence: 99%

Treatment of upper extremity palsies, gunshot wounds and scaphoid nonunion: my preferred approaches

Luria

2022

J Hand Surg Eur Vol

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The article reviews key considerations and our preferred methods in treating upper extremity palsies, gunshot wounds and scaphoid nonunion. For these three difficult conditions, I highlight the importance of a team approach when treating upper extremity neuromuscular disease, flexibility and creativity when treating gunshot wounds, and my personal protocol for dealing with scaphoid fracture nonunions. Level of evidence: V

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“…Аналі з досвіду військових дій останнього часу (Афганістан, Чечня, Югославія, Ірак, Схід України тощо) доводить, що відсоток ушкоджень нервів серед поранених може коливатись від 9 до 25% [5,6,7,8] із подібним співвідношенням для верхньої та нижньої кінцівок. Ушкодження м'язів поряд із травмуванням нервів, як правило, є одним із вирішальних факторів, що унеможливлює відновлення функції пораненої кінцівки та повернення поранених бійців до професійних обов'язків [9].…”

Section: тактика хірургічного лікування поранених із вогнепальними травмами верхньої кінцівки в сучасних умовахunclassified

Tactics of Surgical Treatment of Wounded with Gunshot Injuries of the Upper Limb in Modern Conditions

Страфун

Kurinnyi

Borzykh³

et al. 2021

HOTP

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Summary. Our study aimed to optimize the tactics of surgical treatment of wounded with gunshot wounds of the upper extremity by determining the factors influencing the outcome of treatment of servicemen in modern conditions of specialized and highly specialized medical care. Materials and Methods. Surgical treatment of 123 patients with gunshot wounds of the upper extremity who were treated at the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine” and the National Military Medical Clinical Center “Main Military Clinical Hospital” of the Ministry of Defense of Ukraine was analyzed. The mean age of patients was (35.3±8.7). At the level III of medical care, the largest share was occupied by wound closure (28.0%) and surgeries on the skeletal system (6.7%). At the level IV of medical care, the largest share was occupied by surgical procedures for closing unhealed wounds – 28%, due to the consequences of gunshot nerve injuries – 11.5%, fractures – 10.7%, and restorative interventions on muscles – 5.5%. Results. By calculating the odds ratio (Odds Ratio, OR), it was found that the presence of compartment syndrome reduces the probability of obtaining a positive result by 11 times (OR=11.3), and late treatment at the level IV of care reduces the effectiveness of treatment by 9 times (OR=9.1). In the group of patients with peripheral nerve damage, satisfactory results were 6.9 times less than in the group without such damage (OR=6.9); the presence of a tissue defect worsened the prognosis of treatment by almost 5 times (OR=4.7). The average time to start surgical treatment after a gunshot wound was 2.8±5.0 days at the level III and 47.2±70.4 days at the level IV. It was found that for patients admitted to the level IV facilities for up to 30 days, the percentage increase in upper extremity function was 42.6±11.8 after treatment and 28.5±10.0 at a later start of treatment. Conclusions. The results of the study of the factors influencing the outcome of treatment prove the need for early (up to 3 weeks) admission of wounded with gunshot wounds to the level IV of medical care.

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Management of upper extremity war injuries in the subacute period: A review of 62 cases

Cited by 7 publications

References 49 publications

High Velocity Gunshot Fractures of Humerus: Results of Primary Plate Osteosynthesis

High Velocity Gunshot Fractures of Humerus: Results of Primary Plate Osteosynthesis

Treatment of upper extremity palsies, gunshot wounds and scaphoid nonunion: my preferred approaches

Tactics of Surgical Treatment of Wounded with Gunshot Injuries of the Upper Limb in Modern Conditions

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