Gunshot Wounds to the Hip: Doomed to Failure?
Yiyi Zhang1, Breydan Wright1, Peter D'Amore2
1Saint Louis University School of Medicine, St. Louis, Missouri.
Insights
Gunshot wound (GSW) hip fractures treated surgically often lead to complications like infection and heterotopic ossification. This study highlights these risks in 69 patients, emphasizing that GSW hip injuries are serious and require careful management.
Area of Science:
- Orthopaedic surgery
- Trauma surgery
- Ballistics and injury biomechanics
Background:
- Hip fractures from gunshot wounds (GSW) are complex injuries.
- Surgical intervention is often necessary for GSW hip fractures.
- Understanding complication rates is crucial for patient outcomes.
Purpose of the Study:
- To evaluate surgically treated hip fractures resulting from gunshot wounds (GSW).
- To identify and analyze the complications associated with these injuries.
- To report findings from the largest study to date on surgically managed GSW hip fractures.
Main Methods:
- Retrospective review of patients with low-velocity GSW causing femoral head/neck or intertrochanteric fractures.
- Data collected from three Level 1 Trauma Centers.
- Analysis of surgical treatment and subsequent complications.
Main Results:
- 69 patients (91% male, average age 29) were included.
- High complication rates observed: 9 infections, 6 nonunions, 4 hardware failures, 2 avascular necrosis (AVN), 3 post-traumatic arthritis (PTA), 20 heterotopic ossification (HO).
- No significant difference in complications based on fracture site or fixation type.
Conclusions:
- Surgically treated GSW hip fractures are associated with significant morbidity.
- Infection and heterotopic ossification are the most common complications.
- These injuries are not benign and necessitate comprehensive management strategies.
Abstract:
The purpose is to evaluate hip fractures due to gunshot wounds (GSW) to the hip, which are treated surgically, and the complications. Patients who sustained a low velocity GSW with fracture to the femoral head/neck and intertrochanteric/peritrochantric region at three Level 1 Trauma Centers were eligible. There were 69 patients (63 males-91%), with an average age of 29 (18-60). Nine patients had orthopaedic surgical site infections. There were 6 nonunions, 4 patients with hardware failure, 2 cases of avascular necrosis (AVN), 3 patients with post traumatic arthritis (PTA) and 20 patients with heterotopic ossification (HO). There was no significant difference found regarding fracture site or type of fixation with regards to complications. This represents the largest study of surgically treated GSW to the hip. Of patients studied, 61% sustained additional GSW. These injuries are not benign; the main complications being infection and heterotopic ossification. (Journal of Surgical Orthopaedic Advances 29(3):135-140, 2020).
