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Imaging of the Microstructural Failure Mechanism in the Human Hip
Published on: September 29, 2023
Civilian gunshot fractures of the acetabulum
Anna Antoni1,2, Kirsty Berry1, Kim Laubscher1
1University of Cape Town, Orthopaedic Trauma Service, Division of Orthopaedic Surgery, Private Bag X3, Rondebosch, South Africa.
Aims:
Sparse literature is available for gunshot fractures of the acetabulum. Based on the high risk of hip septic arthritis following bowel content contamination in small case series, most authors recommend washout of the hip. Due to a lack of clear injury definition and differentiation between high- and low-energy fractures in the literature, the aim of the study was to increase the body of knowledge by describing the characteristics, management, and complications of civilian gunshot fractures of the acetabulum. The main research questions were: what is the rate of early infection, and are infection rates increased by associated injuries?
Methods:
Data of all adult patients with civilian acetabulum gunshot fractures treated at a high-volume tertiary hospital betweenJanuary 2009 and December 2022 were retrospectively analyzed.
Results:
We treated 52 patients in the study period. A total of 30 patients (58%) had associated intra-abdominal or urological injuries. Fracture patterns were stable in 96%. Orthopaedic surgical interventions were performed in 15 patients (29%) with removal of bullets as the most frequent procedure (13, 25%). Infections were noted in four patients (8%) with two cases of septic arthritis (4%). Among the patients with infections, there were more trajectories crossing the midline, more blood products used, and more bowel before bone trajectories, statistically non-significant. Displaced fractures had a 50% rate of septic arthritis and large bowel before bone trajectories a 20% rate.
Conclusion:
We could identify characteristics and complications of mostly low-energy civilian acetabulum gunshot fractures, which is novel in the literature. Displaced fractures and large bowel before bone trajectories had the highest rate of septic arthritis, but infection rates were markedly lower than in the literature on bowel content-contaminated hip gunshots. Despite the mainly descriptive nature of the study, the findings could have implications for the surgical management of civilian acetabulum gunshot fractures.
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