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Published on: September 7, 2022
Gunshot wounds to the acetabulum
Soheil Najibi1, Joel M Matta, Paul J Dougherty
1The Hip & Pelvis Institute, St John's Health Center, Santa Monica, CA 90404, USA. snajibi@pol.net
Objectives:
To classify the fracture patterns of gunshot wounds to the acetabulum; identify the associated injuries and complications; determine the predictors of poor outcome and deep infection; and propose a treatment algorithm based on the results.
Design:
Retrospective review of two trauma registry databases over a 13-year period.
Setting:
Multicenter study.
Patients:
Thirty-nine gunshot wounds to the acetabulum (38 patients).
Intervention:
Treatment strategy was based on infection control by treating bowel and bladder injury, presence/absence of intra-articular lead, pattern, and stability of the fracture.
Main Outcome Measurements:
Merle d'Aubigné score, rate of failures, and complications. Multivariate logistic regression analysis to detect predictors of poor outcome and deep infection.
Results:
There were 32 simple (82%) and seven (18%) associated fracture patterns. Bowel injuries were the most common associated injures. There was a 54% major complication rate. Significant predictors of poor outcome were high-velocity missile, involvement of the acetabular dome, abdominal injury, nerve injury, vascular injury, and male gender. Significant factors associated with deep infection were presence of a bowel injury with primary anastomosis of the bowel and an associated fracture pattern.
Conclusions:
The Letournel classification system can be applied to describe these injuries. The successful treatment of the bowel injury directly correlates to infection control. Diverting colostomy is associated with a reduction of the infection rate. Overall, gunshot wounds to the acetabulum are catastrophic injuries with a high complication rate and poor functional outcome. A multidisciplinary algorithm is proposed for treatment of these complex injuries.
Level Of Evidence:
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
