Department of Orthopaedic Surgery, Ascension Macomb-Oakland Hospital, 27351 Dequindre Rd, Madison Heights, MI 48071, USA.
Department of Orthopaedic Surgery, Ascension Providence, 16001W Nine Mile Rd, Southfield, MI 48075, USA.
Injury. 2024 Apr;55(4):111423. doi: 10.1016/j.injury.2024.111423. Epub 2024 Feb 16.
To examine the effects of RBF (Retained Bullet Fragment) removal at the time of long bone fixation on FRI (fracture related infection) rates in low energy GSI (Gunshot Injury) related fractures.
Retrospective Cohort Study SETTING: Level 1 Academic Trauma Center INTERVENTION: Retrospective review of the impact of RBFs on the risk of FRI when employing internal fixation in low energy GSI (Gunshot Injury) related fractures. In situations where the injury pattern requires surgical fixation, the question arises as to whether or not the RBFs need to be removed to prevent FRI.
Whether or not the RBFs removed in our patient population prevented short- and long-term fracture related infection after low-energy gunshot injury (FRI-LGI).
Of the 2,136 GSI related fractures, 131 patients met inclusion criteria, 81 patients underwent removal (R) of RBFs at the time of internal fixation while 50 patients did not undergo any removal (NR) at time of internal fixation. Among the patients who underwent surgical intervention, (Open Reduction Internal Fixation) ORIF was performed in 55 cases (R: 39; NR: 16), and (Intramedullary Nail) IMN was performed in 76 cases (R: 42; NR: 34). The overall rate of deep FRI-LGI was 6.9 % of the 131-patient cohort. We found that removal of RBFs had a statistically significant impact on the rate of deep FRI-LGI when compared to the NR group (p = 0.031). In the RBF removal group, only two patients (2.4 %) developed deep FRI-LGIs, whereas in the NR group, seven patients (14.0 %) developed deep FRI-LGIs. The incidence of early FRI-LGI was higher in the NR group (median 0.6 months) compared to the R group, which was associated with late FRI-LGIs (median 10.1 months) when they occurred.
In our study population, we found a statistically significantly increased incidence of deep and early FRI-LGI when RBFs are not removed at the time of extra-articular long bone internal fixation. The presence of retained bullet fragments following internal fixation may pose a risk factor for future development of deep FRI-LGI. We believe a surgeon should use their best judgment as to whether a RBF can safely be removed at the time of long bone fixation. Based on our findings, if safely permitted, RBF removal should be considered at the time of GSI long bone fixation resulting from low energy hand gun injuries.
探讨在长骨固定时清除弹片（RBF）对低能性 GSI（枪伤）相关骨折骨折相关感染（FRI）发生率的影响。
回顾性队列研究。
一级学术创伤中心。
回顾性分析弹片对低能性 GSI（枪伤）相关骨折内固定时 FRI 风险的影响。在需要手术固定的损伤模式下，弹片是否需要清除以预防 FRI 是一个问题。
在我们的患者人群中，RBF 的清除是否能预防低能量枪击伤后短期和长期的骨折相关感染（FRI-LGI）。
在 2136 例 GSI 相关骨折中，131 例符合纳入标准，81 例在进行内固定时行 RBF 清除术（R 组），50 例在进行内固定时不行任何清除术（NR 组）。在接受手术干预的患者中，行切开复位内固定术（ORIF）55 例（R 组 39 例，NR 组 16 例），行髓内钉（IMN）治疗 76 例（R 组 42 例，NR 组 34 例）。131 例患者的总体深部 FRI-LGI 发生率为 6.9%。我们发现，与 NR 组相比，RBF 清除组的深部 FRI-LGI 发生率具有统计学意义（p = 0.031）。在 RBF 清除组中，只有 2 例（2.4%）发生深部 FRI-LGI，而 NR 组有 7 例（14.0%）发生深部 FRI-LGI。NR 组的早期 FRI-LGI 发生率较高（中位数 0.6 个月），与晚期 FRI-LGI 相关（中位数 10.1 个月）。
在我们的研究人群中，我们发现当关节外长骨内固定时不清除弹片时，深部和早期 FRI-LGI 的发生率明显增加。内固定后遗留的弹片碎片可能是未来深部 FRI-LGI 发展的一个危险因素。我们认为，外科医生应该根据自己的最佳判断，决定是否可以安全地在长骨固定时清除弹片。根据我们的发现，如果允许安全清除，在低能性手枪伤导致的 GSI 长骨固定时应考虑清除弹片。
