The management of low velocity transarticular gunshot injuries: A pilot study
Keywords:septic arthritis, wound infection, civilian gunshot wounds, transarticular injuries
Objectives: To prospectively evaluate the incidence of superficial and deep wound sepsis in a cohort of patients who sustained low velocity transarticular gunshot wounds.
Methods: We performed a prospective, randomised, non-blinded pilot study of all adults presenting to a single institution between November 2011 and January 2015 that sustained a transarticular gunshot injury with no definite indication for surgery. We defined indications for surgery as: retained bullet or bullet fragments that warranted surgical removal or the presence of skeletal injuries that required surgical intervention. Patients were randomised into two treatment groups. The conservative treatment group received antitetanus toxoid and antibiotics alone, and the surgical treatment group received anti-tetanus toxoid and antibiotics, as well as formal arthrotomy, debridement and irrigation.
Setting: Single Level 1 University Hospital Trauma Centre.
Main outcome measurements: The two groups were assessed for development of septic arthritis or superficial wound infection.
Results: We identified 30 transarticular gunshot wounds in 29 patients with an average age of 29.5 years (range 18–74). Sixteen (53%) were treated conservatively and 14 (47%) had a formal arthrotomy and washout. The median follow-up period was 20 days (range 5–84) for the conservative group and 30 days (range 8–84) for the operative group. No wound or intra-articular sepsis was observed for any of the 30 gunshot wounds.
Conclusion: It can be concluded, with appropriate caution, that there may be a place for non-operative treatment of low-velocity transarticular gunshot injuries without a demonstrable increased risk of infection.
Level of evidence: Level 2