Transarticular gunshot injuries: a systematic review of 150 years of management

Authors

Keywords:

gunshot, ballistic, joint, transarticular, intra-articular

Abstract

Background: This review aims to collate all published work on the management of transarticular gunshot injuries to better inform decision-making when managing these injuries.

Methods: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta- Analysis (PRISMA) was undertaken. A literature search of major electronic databases was conducted to identify journal articles relating to the management of transarticular gunshot injuries published from database inception until 31 January 2021.

Results: Sixty-eight publications reporting on the management of 544 patients were included. Injuries to the lower limbs were reported in 438 cases (81%), while injuries to the upper limb accounted for 106 cases (19%). A total of 145 patients (27%) developed a deep infection. Following the routine use of antibiotics, 6% of patients (14/251) developed an infection. A  significantly higher hip joint infection rate was seen in patients who sustained associated hollow viscus injury (11/30, 37%).

Conclusion: The management of transarticular gunshot injuries is currently based on limited high-quality evidence. Modern antibiotic and surgical management practices have resulted in low overall septic complications; however, different joints have different injury and complication profiles. Future research should be aimed at identifying joint-specific evidence-based care pathways.

Level of evidence: Level 4

Author Biographies

Nando Ferreira, Stellenbosch University

Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Cameron Anley, Stellenbosch University

Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Etienne Joubert, Stellenbosch University

Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

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Published

2022-03-16

Issue

Section

Current Concept Review

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