Operative Versus Nonoperative Management Of Traumatic Arthrotomies from Civilian Gunshot Wounds

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Infectious Disease

Background:

• Gunshot wounds (GSW) are an increasing cause of non-fatal injuries.
• Traumatic arthrotomies from GSW require careful management to prevent infection.
• Limited comparative data exists on operative versus nonoperative treatment for GSW-related traumatic arthrotomies, particularly regarding infection risk.

Purpose of the Study:

• To compare the risk of septic arthritis in patients with traumatic arthrotomies caused by GSW.
• To evaluate the effectiveness of operative (irrigation and debridement) versus nonoperative (antibiotics and wound care) treatment strategies.
• To analyze infection rates following different management approaches for GSW-related joint injuries.

Main Methods:

• Retrospective review of 46 patients with traumatic arthrotomies from low-velocity GSW (2009-2016).
• Comparison of infection rates between 8 nonoperatively treated patients and 38 operatively treated patients.
• Follow-up for at least 90 days to assess for septic arthritis and superficial wound infections.

Main Results:

• The knee was the most frequently affected joint (73.9%).
• One patient (12.5%) in the nonoperative group developed a superficial infection; one patient (2.6%) in the operative group developed a superficial infection.
• No statistically significant difference in infection risk (P = 0.32) or septic arthritis was observed between the groups.

Conclusions:

• Nonoperative management with wound care and antibiotics may be adequate for preventing infection in select cases of GSW-related traumatic arthrotomies.
• Further randomized studies and treatment algorithms are needed to guide management of this common injury.
• No patient in either treatment group developed septic arthritis, suggesting favorable outcomes for both approaches in this cohort.