Treatment of gunshot open fractures by external fixator : experience at king hussein medical center

Abstract EN

Objective: To report the clinical efficacy of external fixator used for the management of gunshot induced open fractures and to report our experience at King Hussein Medical Center. Methods: The medical records of 60 patients with open gunshot extremity fractures, treated at King Hussein Medical Center from January 1999 to January 2004, were reviewed retrospectively.

Only patients with diaphyseal comminuted fractures were included in this study.

All patients had debridement, antibiotic therapy, and stabilization of the fracture with an external fixator (either the self-made external fixator using plastic tube and bone cement or the AO tubular system).

The external fixator was left in place for 6-54 (average 16) weeks.

Clinical follow up ranged from 18-36 months after operation with an average of 26 months. Results: Low-velocity fractures occurred in 25 patients.

High-velocity fractures occurred in 35 patients.

All fractures were open, comminuted and displaced.

Eight cases of nerve injury were seen (13%).

Arterial injuries were present in 9 patients (15%).

Clinical evidence of wound infection was documented in the records of 14 patients (23%) including pin tract infections (10%).

The tibia and femur were the most frequent sites accounting for 11 infections, with only three located in the upper extremity.

Three patients had septicemia and four had chronic osteomyelitis.

The wounds healed by granulation tissue in 47 patients; seven had secondary closure, and four had split skin grafts, two had free flaps. Conclusion: The complications associated with gunshot injuries could be reduced to the minimum if the basic principles of management are strictly adhered to.

External fixation is the preferred initial treatment for stabilizing severe open missile fractures.

We recommend this treatment for low-velocity and high- velocity gunshot open fractures.