Low-Velocity Gunshot Femur Fractures Do Not Require Surgical Debridement

Background/Objectives: Management of low-velocity gunshot fractures is controversial, and the need for surgical debridement is being debated. This study aimed to compare the infection and union rate of low-velocity gunshot femur fractures treated without formal debridement to those of closed femur fractures due to blunt trauma. Methods: This is a retrospective comparative study of patients with low-velocity gunshot femur fractures to age- and gender-matched controls with closed femur fractures due to blunt trauma. All patients were treated with intramedullary nailing without exposure and debridement of the fracture site. Outcome variables included fracture-related infection, superficial infection, and union. Statistical significance was set at p < 0.05. Results: The gunshot group consisted of 26 patients (96% male, median age 23 years) and the control group of 52 patients (96% male, median age 23 years. The gunshot group had a significantly lower proportion of additional musculoskeletal injuries compared to the control group (15% vs. 48%, p = 0.006) and a higher proportion of smoking (70% versus 27%, p = 0.001). There were no fracture-related infections in the gunshot group, whereas there was one (2%) in the control group, which was not statistically significant (p = 1.00). There were no superficial infections in either group. All fractures were united in both groups. Conclusions: Low-velocity gunshot femur fractures treated with antibiotics but without debridement have similar infection and union rates as closed femur fractures due to blunt trauma. Low-velocity gunshot femur fractures behave as closed fractures, and formal surgical debridement is not indicated.