Gunshot Fractures of the Forearm: A Multicenter Evaluation

David R. Veltre; Paul Tornetta; Peter Krause; Mary P. George; Heather Vallier; Mai P. Nguyen; Michael S. Reich; Lisa Cannada; Michael Eng; Anna N. Miller; Alexandra Goodwin; Hassan R. Mir; Charles Clark; Ben Sandberg; Jerald R. Westberg; Brian H. Mullis; Jonathan P. Behrens; Reza Firoozabadi

doi:10.1097/BOT.0000000000002056

Gunshot Fractures of the Forearm: A Multicenter Evaluation

David R. Veltre, Paul Tornetta, Peter Krause, Mary P. George, Heather Vallier, Mai P. Nguyen, Michael S. Reich, Lisa Cannada, Michael Eng, Anna N. Miller, Alexandra Goodwin, Hassan R. Mir, Charles Clark, Ben Sandberg, Jerald R. Westberg, Brian H. Mullis, Jonathan P. Behrens, Reza Firoozabadi

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Abstract

OBJECTIVES: To evaluate a large series of open fractures of the forearm after gunshot wounds (GSWs) to determine complication rates and factors that may lead to infection, nonunion, or compartment syndrome. DESIGN: Multicenter retrospective review. SETTING: Nine Level 1 Trauma Centers. PATIENTS/PARTICIPANTS: One hundred sixty-eight patients had 198 radius and ulna fractures due to firearm injuries. All patients were adults, had a fracture due to a firearm injury, and at least 1-year clinical follow-up or follow-up until union. The average follow-up was 831 days. INTERVENTION: Most patients (91%) received antibiotics. Formal irrigation and debridement in the operating room was performed in 75% of cases along with either internal fixation (75%), external fixation (6%), or I&D without fixation (19%). MAIN OUTCOME MEASURES: Complications including neurovascular injuries, compartment syndrome, infection, and nonunion. RESULTS: Twenty-one percent of patients had arterial injuries, and 40% had nerve injuries. Nine patients (5%) developed compartment syndrome. Seventeen patients (10%) developed infections, all in comminuted or segmental fractures. Antibiotics were not associated with a decreased risk of infection. Infections in the ulna were more common in fractures with retained bullet fragments and bone loss. Twenty patients (12%) developed a nonunion. Nonunions were associated with high velocity firearms and bone defect size. CONCLUSIONS: Open fractures of the forearm from GSWs are serious injuries that carry high rates of nonunion and infection. Fractures with significant bone defects are at an increased risk of nonunion and should be treated with stable fixation and proper soft-tissue handling. Ulna fractures are at a particularly high risk for deep infection and septic nonunion and should be treated aggressively. Forearm fractures from GSWs should be followed until union to identify long-term complications. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Original language	English
Pages (from-to)	e364-e370
Journal	Journal of orthopaedic trauma
Volume	35
Issue number	10
DOIs	https://doi.org/10.1097/BOT.0000000000002056
State	Published - Oct 1 2021

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Veltre, D. R., Tornetta, P., Krause, P., George, M. P., Vallier, H., Nguyen, M. P., Reich, M. S., Cannada, L., Eng, M., Miller, A. N., Goodwin, A., Mir, H. R., Clark, C., Sandberg, B., Westberg, J. R., Mullis, B. H., Behrens, J. P., & Firoozabadi, R. (2021). Gunshot Fractures of the Forearm: A Multicenter Evaluation. Journal of orthopaedic trauma, 35(10), e364-e370. https://doi.org/10.1097/BOT.0000000000002056

@article{c37ae30bd6f84c06a5501f09a1b295c4,

title = "Gunshot Fractures of the Forearm: A Multicenter Evaluation",

abstract = "OBJECTIVES: To evaluate a large series of open fractures of the forearm after gunshot wounds (GSWs) to determine complication rates and factors that may lead to infection, nonunion, or compartment syndrome. DESIGN: Multicenter retrospective review. SETTING: Nine Level 1 Trauma Centers. PATIENTS/PARTICIPANTS: One hundred sixty-eight patients had 198 radius and ulna fractures due to firearm injuries. All patients were adults, had a fracture due to a firearm injury, and at least 1-year clinical follow-up or follow-up until union. The average follow-up was 831 days. INTERVENTION: Most patients (91%) received antibiotics. Formal irrigation and debridement in the operating room was performed in 75% of cases along with either internal fixation (75%), external fixation (6%), or I&D without fixation (19%). MAIN OUTCOME MEASURES: Complications including neurovascular injuries, compartment syndrome, infection, and nonunion. RESULTS: Twenty-one percent of patients had arterial injuries, and 40% had nerve injuries. Nine patients (5%) developed compartment syndrome. Seventeen patients (10%) developed infections, all in comminuted or segmental fractures. Antibiotics were not associated with a decreased risk of infection. Infections in the ulna were more common in fractures with retained bullet fragments and bone loss. Twenty patients (12%) developed a nonunion. Nonunions were associated with high velocity firearms and bone defect size. CONCLUSIONS: Open fractures of the forearm from GSWs are serious injuries that carry high rates of nonunion and infection. Fractures with significant bone defects are at an increased risk of nonunion and should be treated with stable fixation and proper soft-tissue handling. Ulna fractures are at a particularly high risk for deep infection and septic nonunion and should be treated aggressively. Forearm fractures from GSWs should be followed until union to identify long-term complications. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.",

author = "Veltre, {David R.} and Paul Tornetta and Peter Krause and George, {Mary P.} and Heather Vallier and Nguyen, {Mai P.} and Reich, {Michael S.} and Lisa Cannada and Michael Eng and Miller, {Anna N.} and Alexandra Goodwin and Mir, {Hassan R.} and Charles Clark and Ben Sandberg and Westberg, {Jerald R.} and Mullis, {Brian H.} and Behrens, {Jonathan P.} and Reza Firoozabadi",

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month = oct,

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doi = "10.1097/BOT.0000000000002056",

language = "English",

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Veltre, DR, Tornetta, P, Krause, P, George, MP, Vallier, H, Nguyen, MP, Reich, MS, Cannada, L, Eng, M, Miller, AN, Goodwin, A, Mir, HR, Clark, C, Sandberg, B, Westberg, JR, Mullis, BH, Behrens, JP & Firoozabadi, R 2021, 'Gunshot Fractures of the Forearm: A Multicenter Evaluation', Journal of orthopaedic trauma, vol. 35, no. 10, pp. e364-e370. https://doi.org/10.1097/BOT.0000000000002056

TY - JOUR

T1 - Gunshot Fractures of the Forearm

T2 - A Multicenter Evaluation

AU - Veltre, David R.

AU - Tornetta, Paul

AU - Krause, Peter

AU - George, Mary P.

AU - Vallier, Heather

AU - Nguyen, Mai P.

AU - Reich, Michael S.

AU - Cannada, Lisa

AU - Eng, Michael

AU - Miller, Anna N.

AU - Goodwin, Alexandra

AU - Mir, Hassan R.

AU - Clark, Charles

AU - Sandberg, Ben

AU - Westberg, Jerald R.

AU - Mullis, Brian H.

AU - Behrens, Jonathan P.

AU - Firoozabadi, Reza

PY - 2021/10/1

Y1 - 2021/10/1

N2 - OBJECTIVES: To evaluate a large series of open fractures of the forearm after gunshot wounds (GSWs) to determine complication rates and factors that may lead to infection, nonunion, or compartment syndrome. DESIGN: Multicenter retrospective review. SETTING: Nine Level 1 Trauma Centers. PATIENTS/PARTICIPANTS: One hundred sixty-eight patients had 198 radius and ulna fractures due to firearm injuries. All patients were adults, had a fracture due to a firearm injury, and at least 1-year clinical follow-up or follow-up until union. The average follow-up was 831 days. INTERVENTION: Most patients (91%) received antibiotics. Formal irrigation and debridement in the operating room was performed in 75% of cases along with either internal fixation (75%), external fixation (6%), or I&D without fixation (19%). MAIN OUTCOME MEASURES: Complications including neurovascular injuries, compartment syndrome, infection, and nonunion. RESULTS: Twenty-one percent of patients had arterial injuries, and 40% had nerve injuries. Nine patients (5%) developed compartment syndrome. Seventeen patients (10%) developed infections, all in comminuted or segmental fractures. Antibiotics were not associated with a decreased risk of infection. Infections in the ulna were more common in fractures with retained bullet fragments and bone loss. Twenty patients (12%) developed a nonunion. Nonunions were associated with high velocity firearms and bone defect size. CONCLUSIONS: Open fractures of the forearm from GSWs are serious injuries that carry high rates of nonunion and infection. Fractures with significant bone defects are at an increased risk of nonunion and should be treated with stable fixation and proper soft-tissue handling. Ulna fractures are at a particularly high risk for deep infection and septic nonunion and should be treated aggressively. Forearm fractures from GSWs should be followed until union to identify long-term complications. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

AB - OBJECTIVES: To evaluate a large series of open fractures of the forearm after gunshot wounds (GSWs) to determine complication rates and factors that may lead to infection, nonunion, or compartment syndrome. DESIGN: Multicenter retrospective review. SETTING: Nine Level 1 Trauma Centers. PATIENTS/PARTICIPANTS: One hundred sixty-eight patients had 198 radius and ulna fractures due to firearm injuries. All patients were adults, had a fracture due to a firearm injury, and at least 1-year clinical follow-up or follow-up until union. The average follow-up was 831 days. INTERVENTION: Most patients (91%) received antibiotics. Formal irrigation and debridement in the operating room was performed in 75% of cases along with either internal fixation (75%), external fixation (6%), or I&D without fixation (19%). MAIN OUTCOME MEASURES: Complications including neurovascular injuries, compartment syndrome, infection, and nonunion. RESULTS: Twenty-one percent of patients had arterial injuries, and 40% had nerve injuries. Nine patients (5%) developed compartment syndrome. Seventeen patients (10%) developed infections, all in comminuted or segmental fractures. Antibiotics were not associated with a decreased risk of infection. Infections in the ulna were more common in fractures with retained bullet fragments and bone loss. Twenty patients (12%) developed a nonunion. Nonunions were associated with high velocity firearms and bone defect size. CONCLUSIONS: Open fractures of the forearm from GSWs are serious injuries that carry high rates of nonunion and infection. Fractures with significant bone defects are at an increased risk of nonunion and should be treated with stable fixation and proper soft-tissue handling. Ulna fractures are at a particularly high risk for deep infection and septic nonunion and should be treated aggressively. Forearm fractures from GSWs should be followed until union to identify long-term complications. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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U2 - 10.1097/BOT.0000000000002056

DO - 10.1097/BOT.0000000000002056

M3 - Article

C2 - 33813542

AN - SCOPUS:85116959173

SN - 0890-5339

VL - 35

SP - e364-e370

JO - Journal of Orthopaedic Trauma

JF - Journal of Orthopaedic Trauma

IS - 10

ER -

Gunshot Fractures of the Forearm: A Multicenter Evaluation

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