Acute management of low energy civilian gunshot wounds

Low energy gunshot wounds (GSW) sustained in the civilian setting are an increasing burden on the orthopaedic and trauma services. They differ significantly in presentation and therefore treatment when compared to high energy injuries. Initial assessment should focus on assessment of life-threatening blood loss, early antibiotics, soft tissue injury and possible associated injuries (vascular and neurological). Fracture patterns differ from blunt injuries, and this should be considered when planning surgical fixation where appropriate. There is controversy regarding surgical debridement of the bullet tract, but possible iatrogenic complications should be considered with simple entry and exit wounds. Bullets need only be removed when retained metal is exposed to synovial fluid or cerebrospinal fluid. Consensus and high-level multicentre trials are required in future to better guide our assessment and management of these unique, but increasingly more common injuries.