ABSTRACT
PURPOSE: To assess the outcome of surgically fixated femur shaft and distal femur fractures following low-velocity civilian gunshot injuries over a 4-year period. METHODS: A retrospective review was conducted on all patients who sustained femur shaft and distal femur fractures from civilian low-velocity gunshot injuries that required definitive surgical fixation between January 2014 and December 2017. Patient demographics, comorbidities, injury characteristics, duration between injury and surgical fixation and presence of complications were captured. RESULTS: A total of 122 patients (mean age, 29.1 ± 9.5 years) were included. Supracondylar femur fractures (AO 33) accounted for 49% of total injuries, followed by femoral shaft (AO 32) and intra-articular distal femur fractures (AO 33 B & C) with 40% and 11%, respectively. Intramedullary nail fixation was the choice of treatment for femur shaft fractures (49.98%) and supracondylar fractures (63%). Intra-articular injuries were predominantly treated with distal femoral locking plates (85%). Arterial and nerve injuries were the most commonly encountered associated injuries occurring in five patients (4.1%) each. Fracture-related infection was diagnosed in two patients (1.6%). No cases of non-union and compartment syndrome were recorded. CONCLUSION: Femur shaft and supracondylar fractures fixated with intramedullary nails are associated with low complication rates and perfect union rates. Our study suggests that intra-articular distal femur fractures fixated with locking plates and cannulated screws have a high complication rate and poorer surgical outcomes. Non-union and compartment syndrome are rare complications of gunshot femur fractures fixated with either intramedullary nails or locking plates.
Subject(s)
Femoral Fractures, Distal , Femoral Fractures , Fracture Fixation, Intramedullary , Wounds, Gunshot , Humans , Young Adult , Adult , Retrospective Studies , South Africa/epidemiology , Trauma Centers , Femur , Femoral Fractures/surgery , Bone Plates , Bone Nails , Wounds, Gunshot/surgery , Treatment OutcomeABSTRACT
OBJECTIVES: To investigate, in patients with fracture blisters, the time to surgical readiness in those treated with silver-impregnated fibrous hydrocolloid (SFH) dressings compared with those treated with topical silver sulfadiazine (SS) cream and to determine the direct costs associated with both treatments. DESIGN: A single-blind, randomized controlled trial. SETTING: The study was conducted at Tygerberg Hospital, a tertiary care facility, and Worcester Provincial Hospital, a secondary care facility, Western Cape, South Africa. PATIENTS: Patients >18 years of age with one or more fracture blisters overlying fractures requiring surgical fixation were considered for inclusion. MAIN OUTCOME MEASUREMENTS: The main outcome was the time to surgical readiness, after complete re-epithelialization of the affected site, in both groups. The direct cost associated with each treatment and the daily cost associated with hospital stay per day were recorded. RESULTS: At an interim analysis, 70 patients had been enrolled and completed the study protocol with 35 patients per group. Groups were balanced across patient and clinical demographic characteristics. A significant difference of 4 days (95% confidence interval: 2.9-5.1 days, P < 0.001) in the mean time to surgical readiness (SFH group, 5.3 days vs. SS group, 9.3 days) was observed. No difference between the time to surgical procedure as well as the total length of hospital stay between the 2 groups was observed. CONCLUSION: This study reports that SFH dressings are a cost-effective treatment option for the management of fracture blisters evidenced by a significant accelerated time to blister re-epithelialization compared with a commonly described method of SS cream dressings. LEVEL OF EVIDENCE: Therapeutic Level 1. See Instructions for Authors for a complete description of levels of evidence. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
