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Low-Velocity Gunshot Femur Fractures Do Not Require Surgical Debridement
Jessica Bear1, Mary-Kate Erdman1, Lane Shepherd1
1Department of Orthopaedic Surgery, Los Angeles General Medical Center, University of Southern California, Los Angeles, CA 90033, USA.
Journal of Clinical Medicine
|June 12, 2026
Summary
Low-velocity gunshot femur fractures treated without surgical debridement show comparable infection and union rates to blunt trauma fractures. This suggests formal debridement is unnecessary for these gunshot injuries.
Area of Science:
- Orthopedic Surgery
- Trauma Management
- Infectious Disease
Background:
- Management of low-velocity gunshot fractures remains controversial, particularly regarding the necessity of surgical debridement.
- Existing debates question the need for extensive surgical intervention in these specific fracture types.
Purpose of the Study:
- To compare infection and union rates of low-velocity gunshot femur fractures treated non-operatively with closed femur fractures from blunt trauma.
- To evaluate the efficacy of conservative management for low-velocity gunshot femur fractures.
Main Methods:
- Retrospective comparative study matching patients with low-velocity gunshot femur fractures to controls with closed femur fractures from blunt trauma.
- Both groups received intramedullary nailing without fracture site debridement.
- Outcome measures included fracture-related infection, superficial infection, and fracture union.
Main Results:
- No significant difference in fracture-related infections (0% vs. 2%, p=1.00) or superficial infections between groups.
- All fractures achieved union in both the gunshot and blunt trauma groups.
- Gunshot group had fewer associated musculoskeletal injuries (15% vs. 48%) but higher smoking rates (70% vs. 27%).
Conclusions:
- Low-velocity gunshot femur fractures treated with antibiotics and without debridement exhibit similar infection and union rates to closed femur fractures from blunt trauma.
- These findings support the classification of low-velocity gunshot femur fractures as behaving like closed fractures, negating the need for formal surgical debridement.
