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Management of civilian gunshot limb injuries: A comparison of Early Total Care and Damage Control Orthopedics
Ammar Ghabi1, Thibault Druel2, Jean-Baptiste Odent3
1Clinic of Orthopedics and Trauma Surgery, Laveran Military Hospital, 34 Boulevard Laveran, 13013, Marseille, France.
Background:
Gunshot-related limb injuries are increasingly seen in civilian settings. Surgical management may follow either Damage Control Orthopaedics (DCO) or Early Total Care (ETC) principles.
Methods:
We retrospectively analyzed 222 civilian patients with gunshot-related limb injuries treated between 2012 and 2023 across five French trauma centers. Patients were grouped according to initial surgical strategy: DCO or ETC. The primary outcome was bone healing; secondary outcomes included infection rates and reoperations.
Results:
ETC patients showed significantly higher union rates (88 % vs. 76 %) and lower infection and reoperation rates. However, the DCO group presented significantly higher Injury Severity Scores and more frequent vascular and nerve injuries, reflecting greater injury severity.
Conclusion:
ETC may be associated with improved outcomes in selected civilian patients with gunshot limb injuries. However, significant selection bias limits the interpretation of comparative results. Further prospective studies are needed to validate these findings.
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