Management of gunshot injuries to the limbs

ABSTRACT

To define the incidence and nature of gunshot fractures of the limbs and their management experience in the region of Najran, Saudi Arabia and adjoining areas of Yemen. Eighty nine patients with 101 long bone fractures following gunshot were managed between January 1996 to February 1998. The majority of people affected were Yemeni [78%], next were Saudi [16%] and 6% were others. Bulk of fractures fell in Gustilo grade two, three A and B injuries. Femur was the maximum involved bone ie. 58 out of 101, then tibia [20], humerus [12] and radius-ulna [11] in descending order. Management included initial resuscitation and thorough wound debridement followed by fracture stabilization. Implants used were Association of Osteosynthesis nails, interlocking nails. Dynamic Hip Screw, Dynamic Condylar Screw and plates, and flexible Intramedullary nailing with or without bone graft. Over all 66% of fractures had good results while 20% satisfactory and 14% poor results. Few limbs had to undergo amputation due to severe vascular injury. Results were superior in patients who had primary stable internal fixation, particularly locked nails. We recommend repeat and meticulous wound debridement and early stable internal fixation in grade one, two and three A fractures while external fixator and traction may be reserved for three-B and C injuries