Complications Are Infrequent After Humeral Shaft Fractures Due to Low-Energy Gunshot Injuries

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Musculoskeletal Injuries

Background:

• Humerus shaft fractures can result from various mechanisms, including gunshot wounds (GSW) and blunt trauma.
• Understanding the distinct characteristics and outcomes of GSW-related humerus fractures is crucial for effective management.

Purpose of the Study:

• To characterize humerus shaft fractures resulting from low-energy gunshot wounds (GSW).
• To compare the outcomes of GSW humerus fractures with those from blunt injuries.
• To evaluate the incidence of nerve injury, infection, and fracture union in both groups.

Main Methods:

• Retrospective study conducted at an urban Level 1 trauma center.
• Analysis of 403 patients with humerus shaft fractures over 18 years, with a focus on 62 patients with GSW injuries.
• Comparison of fracture union, nerve injury, and infection rates between GSW and blunt trauma groups.

Main Results:

• GSW patients were younger, more likely male, and sustained more isolated injuries.
• High rates of fracture union were observed in both GSW (98%) and blunt injury groups (99%).
• Nerve injury was more frequent in GSW cases (47%) but showed similar recovery rates (78%) to blunt injuries (86%).
• Deep infection rates were low in all groups (1.6% for GSW, 1-4.5% for blunt trauma).

Conclusions:

• Nerve injuries are more common with humerus shaft fractures from GSW but typically resolve without intervention.
• Infection is rare following GSW humerus fractures, with infrequent need for secondary operations.
• Initial nonoperative management is appropriate for most GSW humerus fractures, even with associated radial nerve injury.