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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

Journal of Orthopaedic Trauma
|February 24, 2012
PubMed
Summary

Gunshot wounds to the acetabulum are severe injuries with high complication rates. Effective treatment of associated bowel injuries and using a diverting colostomy can reduce infection risk and improve outcomes.

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Area of Science:

  • Orthopedic Surgery
  • Trauma Surgery
  • Ballistics Medicine

Background:

  • Gunshot wounds to the acetabulum present complex challenges in trauma management.
  • Understanding fracture patterns and associated injuries is crucial for effective treatment.

Purpose of the Study:

  • To classify acetabular gunshot fracture patterns.
  • To identify associated injuries, complications, and predictors of poor outcomes.
  • To propose a treatment algorithm for these injuries.

Main Methods:

  • Retrospective review of 39 acetabular gunshot wounds (38 patients) from two trauma registries over 13 years.
  • Analysis included fracture patterns, associated injuries, treatment strategies, and outcomes (Merle d'Aubigné score, failure rates, complications).
  • Multivariate logistic regression identified predictors of poor outcome and deep infection.

Main Results:

  • 54% major complication rate; 18% associated fracture patterns, with bowel injuries being most common.
  • Predictors of poor outcome included high-velocity missile, acetabular dome involvement, abdominal/nerve/vascular injury, and male gender.
  • Deep infection was associated with bowel injury and primary anastomosis, and associated fracture patterns.

Conclusions:

  • The Letournel classification system is applicable to acetabular gunshot fractures.
  • Successful bowel injury management is key to infection control; diverting colostomy reduces infection rates.
  • These are catastrophic injuries requiring a multidisciplinary approach and a proposed treatment algorithm.