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Treatment and Outcomes for Gunshot Wound Humerus Fractures: A Multicenter Analysis
Adam Haydel1, Eleanor Christianson2, Sam Baum1
1Department of Orthopaedics, Louisiana State University Health Sciences Center and University Medical Center, New Orleans, LA.
Objectives:
To report the injury profile of gunshot wounds (GSWs) to the humerus along with treatment, fracture-related infection (FRI), and nonunion.
Design:
Retrospective review.
Setting:
Multicenter, 12 academic hospitals.
Patient Selection Criteria:
All patients ≥18 years old who presented to the emergency room with GSW-related humerus fractures (Orthopaedic Trauma Association classifications 11-13, types A-C) were included from January 2016 to October 2021. Patients were compared based on surgical management (SM) and nonsurgical management (NoSM).
Outcome Measures And Comparisons:
Data on patient demographics, injury presentation, treatment received, and outcomes including FRI and nonunion were collected. FRI was split into confirmatory and suggestive diagnoses. Multivariable logistic regression evaluated differences between the SM and NoSM groups in FRI after controlling for indicators of injury severity.
Results:
Six hundred fifty-four patients were included with a mean age of 31 years (range: 18-74 years). Five hundred seventy-five patients (88%) were male, and 512 (79%) were Black or African American. Intra-articular fractures were more likely to be managed surgically (SM: 33.4%, NoSM: 17%, P < 0.0001). The rate of vascular injury was significantly higher in SM patients (SM: 16.8%, NoSM: 5.4%, P < 0.001); this was also true for nerve injury (SM: 45.6%, NoSM: 23.9%, P < 0.0001). Among all 654 patients, there was a significant difference in confirmatory FRI (SM: 5.4%, NoSM: 0.4%, P = 0.004) and suggestive FRI (SM: 19.9%, NoSM: 4.4%, P < 0.0001). In the subgroup of 307 patients with at least 90 days of follow-up, a significant difference was observed in suggestive FRI (SM: 22.5%, NoSM: 2.4%, P < 0.0001), but not in confirmatory FRI (SM: 6.8%, NoSM: 1.2%, P = 0.080). The rate of nonunion did not differ significantly between groups in the full cohort (SM: 8.4%; NoSM: 5.3%, P = 0.148) and subgroup with at least 90 days of follow-up (SM: 14.4%; NoSM: 12.9%, P = 0.739). After controlling for indicators of injury severity, the SM group had a significantly higher odds of suggestive FRI than the NoSM group both in the overall cohort (adjusted odds ratio = 2.54; 95% confidence interval: 1.14-5.64; P = 0.023) and among patients with at least 90 days of follow-up (adjusted odds ratio = 5.62; 95% confidence interval: 1.22-25.8; P = 0.027).
Conclusions:
In this study, humerus GSWs managed with surgery were associated with a higher prevalence of suggestive FRI, vascular injury, and nerve injury than GSWs managed without surgery; management (surgery vs. no surgery) was not associated with risk of nonunion.
Level Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
