Gunshot wounds to the acetabulum.

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

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.