Gunshot injuries to the lower extremities: Issues, controversies and algorithm of management.

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Abstract

[Indexed for MEDLINE] 3. J Clin Orthop Trauma. 2026 Jan 13;73:103344. doi: 10.1016/j.jcot.2026.103344. eCollection 2026 Feb. Management of civilian gunshot limb injuries: A comparison of Early Total Care and Damage Control Orthopedics. Ghabi A(1), Druel T(2), Odent JB(3), Pascal-Moussellard H(3), de Geofroy B(1), Mathieu L(4). Author information: (1)Clinic of Orthopedics and Trauma Surgery, Laveran Military Hospital, 34 Boulevard Laveran, 13013, Marseille, France. (2)Department of Orthopedic and Traumatology, Edouard Herriot Hospital, 5 Place d'Arsonval, 69003, Lyon, France. (3)Department of Surgery and Sport Traumatology University Hospital Center Pitié Salpêtrière, 47-83, Boulevard de l'Hôpital, 75013, Paris, France. (4)Clinic of Orthopedics and Trauma Surgery, Percy Military Hospital, 2 rue Lieutenant Raoul Batany, France. BACKGROUND: Gunshot-related limb injuries are increasingly seen in civilian settings. Surgical management may follow either Damage Control Orthopaedics (DCO) or Early Total Care (ETC) principles. METHODS: We retrospectively analyzed 222 civilian patients with gunshot-related limb injuries treated between 2012 and 2023 across five French trauma centers. Patients were grouped according to initial surgical strategy: DCO or ETC. The primary outcome was bone healing; secondary outcomes included infection rates and reoperations. RESULTS: ETC patients showed significantly higher union rates (88 % vs. 76 %) and lower infection and reoperation rates. However, the DCO group presented significantly higher Injury Severity Scores and more frequent vascular and nerve injuries, reflecting greater injury severity. CONCLUSION: ETC may be associated with improved outcomes in selected civilian patients with gunshot limb injuries. However, significant selection bias limits the interpretation of comparative results. Further prospective studies are needed to validate these findings. © 2026 Delhi Orthopedic Association. All rights are reserved, including those for text and data mining, AI training, and similar technologies. DOI: 10.1016/j.jcot.2026.103344 PMCID: PMC12859785