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Outcomes and Management for Ballistic Traumatic Arthrotomies in Children
Nicholas L Newcomb1, Devin A Maez, Samuel L Flesner
1Department of Orthopaedic Surgery, University of New Mexico Health Science Center, Albuquerque, NM.
Insights
Operative irrigation and debridement (I&D) is not necessary for pediatric traumatic arthrotomies from gunshot wounds to prevent joint infections. Prolonged antibiotic use also did not impact infection rates in this study.
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.
Objectives:
To evaluate whether operative irrigation and debridement (I&D) is necessary for the treatment of pediatric traumatic arthrotomies (TAs) secondary to gunshot wounds (GSWs) to prevent joint infections.
Design:
Retrospective cohort study.
Setting:
US Academic Level I Trauma Center.
Patient Selection Criteria:
Pediatric patients (age 0-17) with TAs secondary to GSW between 2016 and 2023 with at least 1-month follow-up were included. Arthrotomies included shoulder, elbow, wrist, hand, sacroiliac, hip, knee, ankle, or foot joints.
Outcome Measures And Comparisons:
The primary outcome was rate of joint infection between those who received acute operative I&D versus those who received nonoperative management. A subanalysis was completed only comparing "major joints." Within the cohorts, length of antibiotic treatment was compared.
Results:
Fifty seven cases of ballistic TA (50 subjects, 82% male, mean age 14.6 years) were included. In total, 31 of 57 joints (54.4%) underwent formal operative I&D with or without fixation, while 26 joints (45.6%) did not. In the operative I&D cohort, 85% were male with a mean age 14.8 years versus 79% male with mean age of 14.3 years in the nonoperative group. Mean follow-up duration was 10.8 months (range 1-56 months) for both cohorts. No joint infections were documented between either group, regardless of treatment ( P = 1.0). In total, 38 TAs were major joints: 23 of 38 (60.5%) received I&D, while 15 of 38 (39.5%) did not. All joints received at least 1 dose of intravenous (IV) antibiotics. Among the operative group, 54.8% of joints received ≤72 hours of IV antibiotics (45.2% received >72 hours), compared with 46.2% of joints in the nonoperative group (53.8% received >72 hours).
Conclusions:
Formal operative I&D was not found to be necessary to prevent joint infection after TA secondary to GSW. Prolonged antibiotic use did not affect rates of infection.
Level Of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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