Management of civilian gunshot injuries of the femur. A review of the literature.

Gunshot fractures of the femur are becoming more commonplace in modern civilization. The initial assessment must accurately document the vascular and neurological status of the limb as well as the characteristics of the fracture. Low velocity gunshot wounds require a brief course of broad spectrum intravenous prophylactic antibiotics and limited surgical debridement of the wound. Definitive stabilization should consist of locked, reamed, intramedullary nailing for low velocity injuries, and non-reamed nailing for high velocity injuries. External or plate fixations are best reserved for the more severe Grade IIIC injuries. Successful limb salvage is most dependent on the associated vascular injury, while neurological injury is a major determinant of long-term disability.