Abstract | OBJECTIVES: To classify the fracture patterns of gunshot wounds to the acetabulum; identify the associated injuries and complications; determine the predictors of poor outcome and deep infection; and propose a treatment algorithm based on the results. DESIGN: Retrospective review of two trauma registry databases over a 13-year period. SETTING: Multicenter study. PATIENTS: INTERVENTION: Treatment strategy was based on infection control by treating bowel and bladder injury, presence/absence of intra-articular lead, pattern, and stability of the fracture. MAIN OUTCOME MEASUREMENTS: Merle d'Aubigné score, rate of failures, and complications. Multivariate logistic regression analysis to detect predictors of poor outcome and deep infection. RESULTS: There were 32 simple (82%) and seven (18%) associated fracture patterns. Bowel injuries were the most common associated injures. There was a 54% major complication rate. Significant predictors of poor outcome were high-velocity missile, involvement of the acetabular dome, abdominal injury, nerve injury, vascular injury, and male gender. Significant factors associated with deep infection were presence of a bowel injury with primary anastomosis of the bowel and an associated fracture pattern. CONCLUSIONS: The Letournel classification system can be applied to describe these injuries. The successful treatment of the bowel injury directly correlates to infection control. Diverting colostomy is associated with a reduction of the infection rate. Overall, gunshot wounds to the acetabulum are catastrophic injuries with a high complication rate and poor functional outcome. A multidisciplinary algorithm is proposed for treatment of these complex injuries. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Authors | Soheil Najibi, Joel M Matta, Paul J Dougherty, Moritz Tannast |
Journal | Journal of orthopaedic trauma
(J Orthop Trauma)
Vol. 26
Issue 8
Pg. 451-9
(Aug 2012)
ISSN: 1531-2291 [Electronic] United States |
PMID | 22357085
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Topics |
- Acetabulum
(injuries)
- Adolescent
- Adult
- Age Distribution
- Aged
- Comorbidity
- Female
- Humans
- Incidence
- Male
- Middle Aged
- Postoperative Complications
(epidemiology)
- Registries
- Risk Factors
- Sex Distribution
- Treatment Outcome
- United States
(epidemiology)
- Wounds, Gunshot
(epidemiology, surgery)
- Young Adult
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