Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Management of gunshot wounds near the elbow: experiences at a high-volume level I trauma center

  • Umar Ghilzai (Department of Orthopedics, Baylor College of Medicine) ;
  • Abdullah Ghali (Department of Orthopedics, Baylor College of Medicine) ;
  • Aaron Singh (Department of Orthopaedics, UT Health San Antonio) ;
  • Thomas Wesley Mitchell (Department of Orthopedics, Baylor College of Medicine) ;
  • Scott A. Mitchell (Department of Orthopedics, Baylor College of Medicine)
  • Received : 2023.09.11
  • Accepted : 2023.10.17
  • Published : 2024.03.01
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Abstract

Background: Gunshot-related fractures near the elbow are challenging, and available data to guide the practitioner are lacking. This report analyzes injury patterns and treatment strategies in a case series from a high-volume urban trauma center. Methods: All periarticular gunshot fractures near the elbow treated at a level 1 trauma center from 2014 to 2018 were retrospectively reviewed. Fracture location, patient demographics, concomitant injuries, treatment modalities, and complications were analyzed. Results: Twenty-four patients were identified. All patients received prophylactic antibiotics upon admission and underwent urgent surgical debridement. Open reduction and internal fixation (ORIF) was performed with initial debridement in 22 of 24 patients. Seven patients sustained distal humerus fractures, 10 patients sustained isolated proximal ulna or proximal radius fractures, and seven had combined fracture patterns. Eleven patients presented with nerve palsy, and two had transected nerves. Two patients had vascular injury requiring repair. One patient required a temporary elbow-spanning external fixator and underwent staged debridement followed by ORIF. One patient with a grade IIIC fracture developed a deep infection that precluded ORIF. One patient required revision ORIF due to fracture displacement. Conclusions: This investigation reports on management of ballistic fractures near the elbow at a busy urban level I trauma center. Our management centered on rapid debridement, early definitive fixation, and intravenous antibiotic administration. We report on associated neurovascular injury, bone loss, and other challenges in this patient population. Level of evidence: IV.

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References

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