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Gunshot wounds to the acetabulum.

AbstractOBJECTIVES:
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:
Thirty-nine gunshot wounds to the acetabulum (38 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.
AuthorsSoheil Najibi, Joel M Matta, Paul J Dougherty, Moritz Tannast
JournalJournal of orthopaedic trauma (J Orthop Trauma) Vol. 26 Issue 8 Pg. 451-9 (Aug 2012) ISSN: 1531-2291 [Electronic] United States
PMID22357085 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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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