Department of Orthopaedic Surgery, Virginia Commonwealth University, 1200 East Broad Street, PO Box 980153, Richmond, VA 23298, USA.
Virginia Commonwealth University School of Medicine, 1201 E Marshall St #4-100, Richmond, VA, USA.
Injury. 2023 Jul;54(7):110772. doi: 10.1016/j.injury.2023.04.056. Epub 2023 May 2.
Ballistic injuries to the upper extremity represent a small subset of injuries, and there is little data to provide guidance on management and outcomes. The purpose of this study is to assess the incidence of neurovascular injuries, compartment syndrome, and early postoperative infection, as well as patient and injury factors predictive of neurovascular injury following ballistic fractures of the forearm.
A retrospective review of operatively treated ballistic forearm fractures at a single level I trauma center between 2010 and 2022 was performed. Thirty-three patients with 36 forearm fractures were identified. Only diaphyseal injuries in patients greater than 18 years old were included. Medical and radiographic records were reviewed to identify pre-injury patient-specific factors, including age, sex, smoking status, and history of diabetes. Injury characteristics, including the type of firearm used, forearm fracture location, and any associated neurologic or vascular injury, as well as compartment syndrome, were collected and analyzed. Short-term outcomes such as post-operative infection and recovery of neurologic function were also collected and analyzed.
The median age was 27 years (range: 18-62), with a majority of male patients (78.8%, n = 26). 4 patients (12.1%) sustained high-energy injuries. 4 patients (12.1%) were found to have compartment syndrome pre-operatively or intra-operatively. 11 patients (33.3%) had nerve palsies postoperatively with 8 patients (24.2%) continuing to have nerve palsies at their final follow-up (mean follow-up= 149.9 +/- 187.2 days). The median length of stay was 4 days. There were no patients with infection at follow-up.
Ballistic forearm fractures are complex injuries and can result in severe complications such as neurovascular injury and compartment syndrome. As such, a comprehensive evaluation and appropriate management of ballistic forearm fractures are essential to minimize the risk of severe complications and optimize patient outcomes. In our experience, when treated operatively, these injuries have a low rate of infection.
上肢的弹道伤占比较小，目前有关管理和结果的指导数据较少。本研究旨在评估神经血管损伤、筋膜室综合征和早期术后感染的发生率，以及预测前臂弹道骨折后神经血管损伤的患者和损伤因素。
回顾性分析了 2010 年至 2022 年期间在一家一级创伤中心接受手术治疗的前臂弹道骨折患者。共确定了 33 例 36 例前臂骨折患者。仅纳入年龄大于 18 岁的患者的骨干损伤。回顾了医疗和影像学记录，以确定术前患者的特定因素，包括年龄、性别、吸烟状况和糖尿病史。收集并分析了损伤特征，包括使用的枪支类型、前臂骨折位置以及任何相关的神经或血管损伤，以及筋膜室综合征。还收集和分析了短期结果，如术后感染和神经功能恢复情况。
中位年龄为 27 岁（范围：18-62 岁），大多数为男性（78.8%，n=26）。4 例（12.1%）患者发生高能损伤。4 例（12.1%）患者术前或术中发现筋膜室综合征。11 例（33.3%）患者术后出现神经麻痹，8 例（24.2%）患者在最终随访时仍存在神经麻痹（平均随访时间=149.9 +/- 187.2 天）。中位住院时间为 4 天。随访时无感染患者。
前臂弹道骨折是复杂的损伤，可导致严重并发症，如神经血管损伤和筋膜室综合征。因此，全面评估和适当的管理前臂弹道骨折对于降低严重并发症的风险和优化患者预后至关重要。根据我们的经验，这些损伤经手术治疗后感染率较低。
