Outcomes and Management for Ballistic Traumatic Arthrotomies in Children

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Pediatric Surgery

Background:

• Traumatic arthrotomies (TAs) in pediatric patients resulting from gunshot wounds (GSWs) pose a risk of joint infection.
• The necessity of operative irrigation and debridement (I&D) in managing these injuries remains a critical clinical question.

Purpose of the Study:

• To determine if operative I&D is essential for preventing joint infections in pediatric patients with TAs secondary to GSWs.
• To compare infection rates between operative I&D and nonoperative management for these injuries.

Main Methods:

• A retrospective cohort study was conducted at a US Academic Level I Trauma Center.
• Pediatric patients (0-17 years) with TAs from GSWs between 2016-2023 were included, with follow-up of at least one month.
• The primary outcome was the rate of joint infection, comparing operative I&D versus nonoperative management, with a sub-analysis for major joints.

Main Results:

• The study included 57 cases of ballistic TA in 50 pediatric patients. 54.4% underwent operative I&D, while 45.6% received nonoperative management.
• No joint infections were documented in either the operative or nonoperative groups (p=1.0).
• Antibiotic treatment duration did not correlate with infection rates; 45.2% of the operative group and 53.8% of the nonoperative group received >72 hours of IV antibiotics.

Conclusions:

• Formal operative I&D is not a necessary intervention to prevent joint infections following traumatic arthrotomies secondary to gunshot wounds in pediatric patients.
• The duration of antibiotic treatment did not influence the occurrence of joint infections in this cohort.