Geissler W B, Teasedall R D, Tomasin J D, Hughes J L
Department of Orthopaedics University of Mississippi Medical Center, Jackson 39216.
J Orthop Trauma. 1990;4(1):39-41. doi: 10.1097/00005131-199003000-00007.
Bullets fired from civilian weapons are usually of low velocity, resulting in minimal tissue cavitation as compared to high-velocity weapons. A prospective protocol was initiated for patients sustaining a low-velocity gunshot to the extremity resulting in a stable, nonoperative fracture configuration. Treatment consisted of local irrigation and débridement, tetanus prophylaxis as required, a long acting cephalosporin intramuscularly, and splinting or casting of the fractured extremity. Twenty-five patients were managed by this protocol. This patient population was compared to a random retrospective sample of 25 patients with similar ballistic induced fractures and wounds managed by local débridement and 48 h of intravenous antibiotics. One infection occurred in each group, requiring further therapy. We conclude that the patient with a low-velocity gunshot induced fracture can be managed without the use of short-term intravenous antibiotics with no increased risk of infection.
民用武器发射的子弹通常速度较低，与高速武器相比，其造成的组织空化作用最小。针对因低速枪伤导致四肢骨折且骨折情况稳定、无需手术的患者启动了一项前瞻性方案。治疗包括局部冲洗和清创、根据需要进行破伤风预防、肌肉注射长效头孢菌素以及对骨折肢体进行夹板固定或石膏固定。25例患者按照该方案进行治疗。将该患者群体与25例由局部清创和48小时静脉抗生素治疗的类似弹道伤所致骨折和伤口的随机回顾性样本进行比较。每组均发生1例感染，需要进一步治疗。我们得出结论，低速枪伤所致骨折的患者无需使用短期静脉抗生素治疗，且感染风险不会增加。
