The role of débridement in low-velocity civilian gunshot injuries resulting in pelvis fractures

A retrospective review of acute infection and inpatient mortality

Jason Watters, Jeffrey O. Anglen, Brian Mullis

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives: To determine the use of surgical débridement in the management of low-velocity gunshot injuries (GSIs) resulting in pelvis fractures. Design: Retrospective chart review. Setting: Level I trauma center in a major metropolitan area. Patients: Fifty-six patients from 1991 to 2007 treated for pelvis GSIs with resulting pelvis fractures with six acute mortalities and 40 patients with at least 1-year follow-up. Intervention: Patient data were reviewed for incidence of infection related to pelvis GSIs. Information regarding surgical débridement of pelvis GSI wounds, retained foreign bodies, and/or concomitant gastrointestinal (GI) injury was analyzed for relationships of such events to infection rate. Main Outcome Measurements: Incidence of infection related to pelvis GSIs at least 1 year after GSI date. Results: Three patients (6%) developed a deep infection related to their pelvis GSIs. There were no cases of osteomyelitis. The rate of concomitant GI injuries was 36% and the overall infection rate among those with GI injuries was 12% versus 3% for those without a GI injury (P = 0.34). There were infection rates of 7% and 6% among patients who underwent surgical débridement and those who did not, respectively. Of those with GI injuries, 41% underwent primary surgical débridement and none developed infection. In the group of remaining patients with GI injuries who did not undergo débridement of their GSI wounds, two (20%) developed an infection. The mortality rate of low-energy GSIs to the pelvis was six of 53 (11%). Conclusion: There was no increased incidence of infection in the absence of aggressive surgical débridement of pelvis GSI wounds. The study also demonstrated that retained bullets and bullet fragments did not increase the risk of infection, even after penetrating the GI tract organs. Finally, this study suggests there may be an increased risk of infection related to pelvis GSIs compared with reported infection rates related to GSIs of the extremities, likely secondary to a high rate of concomitant GI injuries associated with pelvis GSIs; however, there was no incidence of osteomyelitis.

Original languageEnglish
Pages (from-to)150-155
Number of pages6
JournalJournal of Orthopaedic Trauma
Volume25
Issue number3
DOIs
StatePublished - Mar 2011

Fingerprint

Pelvis
Inpatients
Mortality
Wounds and Injuries
Infection
Gunshot Wounds
Incidence
Osteomyelitis
Trauma Centers
Foreign Bodies

Keywords

  • Débridement
  • Gunshot injury
  • Gunshot wound
  • Infection
  • Pelvic fracture
  • Urban violence

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

@article{080663385ab64f0bbb9f79dafeace6d4,
title = "The role of d{\'e}bridement in low-velocity civilian gunshot injuries resulting in pelvis fractures: A retrospective review of acute infection and inpatient mortality",
abstract = "Objectives: To determine the use of surgical d{\'e}bridement in the management of low-velocity gunshot injuries (GSIs) resulting in pelvis fractures. Design: Retrospective chart review. Setting: Level I trauma center in a major metropolitan area. Patients: Fifty-six patients from 1991 to 2007 treated for pelvis GSIs with resulting pelvis fractures with six acute mortalities and 40 patients with at least 1-year follow-up. Intervention: Patient data were reviewed for incidence of infection related to pelvis GSIs. Information regarding surgical d{\'e}bridement of pelvis GSI wounds, retained foreign bodies, and/or concomitant gastrointestinal (GI) injury was analyzed for relationships of such events to infection rate. Main Outcome Measurements: Incidence of infection related to pelvis GSIs at least 1 year after GSI date. Results: Three patients (6{\%}) developed a deep infection related to their pelvis GSIs. There were no cases of osteomyelitis. The rate of concomitant GI injuries was 36{\%} and the overall infection rate among those with GI injuries was 12{\%} versus 3{\%} for those without a GI injury (P = 0.34). There were infection rates of 7{\%} and 6{\%} among patients who underwent surgical d{\'e}bridement and those who did not, respectively. Of those with GI injuries, 41{\%} underwent primary surgical d{\'e}bridement and none developed infection. In the group of remaining patients with GI injuries who did not undergo d{\'e}bridement of their GSI wounds, two (20{\%}) developed an infection. The mortality rate of low-energy GSIs to the pelvis was six of 53 (11{\%}). Conclusion: There was no increased incidence of infection in the absence of aggressive surgical d{\'e}bridement of pelvis GSI wounds. The study also demonstrated that retained bullets and bullet fragments did not increase the risk of infection, even after penetrating the GI tract organs. Finally, this study suggests there may be an increased risk of infection related to pelvis GSIs compared with reported infection rates related to GSIs of the extremities, likely secondary to a high rate of concomitant GI injuries associated with pelvis GSIs; however, there was no incidence of osteomyelitis.",
keywords = "D{\'e}bridement, Gunshot injury, Gunshot wound, Infection, Pelvic fracture, Urban violence",
author = "Jason Watters and Anglen, {Jeffrey O.} and Brian Mullis",
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N2 - Objectives: To determine the use of surgical débridement in the management of low-velocity gunshot injuries (GSIs) resulting in pelvis fractures. Design: Retrospective chart review. Setting: Level I trauma center in a major metropolitan area. Patients: Fifty-six patients from 1991 to 2007 treated for pelvis GSIs with resulting pelvis fractures with six acute mortalities and 40 patients with at least 1-year follow-up. Intervention: Patient data were reviewed for incidence of infection related to pelvis GSIs. Information regarding surgical débridement of pelvis GSI wounds, retained foreign bodies, and/or concomitant gastrointestinal (GI) injury was analyzed for relationships of such events to infection rate. Main Outcome Measurements: Incidence of infection related to pelvis GSIs at least 1 year after GSI date. Results: Three patients (6%) developed a deep infection related to their pelvis GSIs. There were no cases of osteomyelitis. The rate of concomitant GI injuries was 36% and the overall infection rate among those with GI injuries was 12% versus 3% for those without a GI injury (P = 0.34). There were infection rates of 7% and 6% among patients who underwent surgical débridement and those who did not, respectively. Of those with GI injuries, 41% underwent primary surgical débridement and none developed infection. In the group of remaining patients with GI injuries who did not undergo débridement of their GSI wounds, two (20%) developed an infection. The mortality rate of low-energy GSIs to the pelvis was six of 53 (11%). Conclusion: There was no increased incidence of infection in the absence of aggressive surgical débridement of pelvis GSI wounds. The study also demonstrated that retained bullets and bullet fragments did not increase the risk of infection, even after penetrating the GI tract organs. Finally, this study suggests there may be an increased risk of infection related to pelvis GSIs compared with reported infection rates related to GSIs of the extremities, likely secondary to a high rate of concomitant GI injuries associated with pelvis GSIs; however, there was no incidence of osteomyelitis.

AB - Objectives: To determine the use of surgical débridement in the management of low-velocity gunshot injuries (GSIs) resulting in pelvis fractures. Design: Retrospective chart review. Setting: Level I trauma center in a major metropolitan area. Patients: Fifty-six patients from 1991 to 2007 treated for pelvis GSIs with resulting pelvis fractures with six acute mortalities and 40 patients with at least 1-year follow-up. Intervention: Patient data were reviewed for incidence of infection related to pelvis GSIs. Information regarding surgical débridement of pelvis GSI wounds, retained foreign bodies, and/or concomitant gastrointestinal (GI) injury was analyzed for relationships of such events to infection rate. Main Outcome Measurements: Incidence of infection related to pelvis GSIs at least 1 year after GSI date. Results: Three patients (6%) developed a deep infection related to their pelvis GSIs. There were no cases of osteomyelitis. The rate of concomitant GI injuries was 36% and the overall infection rate among those with GI injuries was 12% versus 3% for those without a GI injury (P = 0.34). There were infection rates of 7% and 6% among patients who underwent surgical débridement and those who did not, respectively. Of those with GI injuries, 41% underwent primary surgical débridement and none developed infection. In the group of remaining patients with GI injuries who did not undergo débridement of their GSI wounds, two (20%) developed an infection. The mortality rate of low-energy GSIs to the pelvis was six of 53 (11%). Conclusion: There was no increased incidence of infection in the absence of aggressive surgical débridement of pelvis GSI wounds. The study also demonstrated that retained bullets and bullet fragments did not increase the risk of infection, even after penetrating the GI tract organs. Finally, this study suggests there may be an increased risk of infection related to pelvis GSIs compared with reported infection rates related to GSIs of the extremities, likely secondary to a high rate of concomitant GI injuries associated with pelvis GSIs; however, there was no incidence of osteomyelitis.

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KW - Gunshot wound

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KW - Urban violence

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