Treating civilian gunshot wounds to the extremities in a level 1 trauma center: our experience and recommendations.

ABSTRACT

BACKGROUND: Gunshot wounds impose a continuous burden on community and hospital resources. Gunshot injuries to the extremities might involve complex soft tissue, bone, vascular, musculotendinous, and nerve injuries. A precise knowledge of anatomy is needed to evaluate and treat those injuries. OBJECTIVES: To review our experience with gunshot wounds to the extremities. METHODS: We retrospectively reviewed all civilian cases of gunshot wounds to the limbs treated in our institution during 2003-2005. Altogether, we evaluated 60 patients with 77 injuries. RESULTS: Of the 60 patients 36 had fractures, 75% of them in the lower extremity and 81% in long bones. The most common fixation modality used was external fixation (33%), followed by intramedullary nailing (25%). This relatively high percentage of fracture treated with external fixation may be attributed to the comminuted pattern of the fractures, the general status of the patient, or the local soft tissue problems encountered in gunshot wounds. About one-fifth of the fractures were treated by debridement only without hardware fixation. We treated 10 vascular injuries in 8 patients; 6 of them were injuries to the popliteal vessels. Fractures around the knee comprised the highest risk factor for vascular injuries, since 5 of the 12 fractures around the knee were associated with vascular injury requiring repair or reconstruction. There were 13 nerve injuries (16.8%), most of them of the deep peroneal nerve (38%). Only three patients had concomitant nerve and vascular injuries. The overall direct complication rate in our series was 20%. CONCLUSIONS: To successfully treat complex gunshot injuries a team approach is necessary. This team should be led by an orthopedic surgeon knowledgeable in the functional anatomy of the limbs.