Unusual cervical spine injury by fishing harpoon.

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Abstract

[Indexed for MEDLINE] 14. Orthop Traumatol Surg Res. 2026 Sep;112(5):104701. doi: 10.1016/j.otsr.2026.104701. Epub 2026 Apr 12. Management of low-energy ballistic limb injuries in French trauma centers. Ghabi A(1), Druel T(2), de Geofroy B(1), James A(3), Odent JB(4), Chateau L(5), Tannyeres P(6), Khiami F(4), Pascal-Moussellard H(4), Mathieu L(7). Author information: (1)Department of Orthopedic and Trauma Surgery, Laveran Military Hospital, 34 boulevard Laveran, 13013 Marseille, France. (2)Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 place d'Arsonval, 69003 Lyon, France. (3)Department of Anesthesia and Resuscitation, University Hospital Center Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France. (4)Department of Surgery and Sport Traumatology, University Hospital Center Pitié Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France. (5)Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France. (6)Department of Orthopedic and Trauma Surgery, Saint-Anne Military Hospital, 2 Bd Sainte-Anne BP600, 83000 Toulon, France. (7)Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 place d'Arsonval, 69003 Lyon, France; Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France; Department of Surgery, French Military Health Service Academy, 1 place Alphonse Laveran, 75005 Paris, France; Military Biomedical Research Institute (IRBA), 1 place Général Valérie André, 91220 Brétigny-sur-Orge, France. Electronic address: laurent.mathieu@chu-lyon.fr. BACKGROUND: Management of high-energy wartime ballistic trauma is well established, but strategies for low-energy civilian injuries remain debated. This study analyzed injury patterns and treatment approaches for low-energy ballistic limb trauma in civilian and military French trauma centers (TCs). METHODS: We conducted a retrospective multicenter study in five Level 1 TCs (2 civilian, 3 military), including adults treated for low-energy ballistic limb injuries between 2012 and 2022. Demographics, injury mechanism and context, injury characteristics, surgical management, and outcomes were analyzed. RESULTS: Among 178 patients with a mean age of 33.4 years, 124 (70%) were treated in civilian TCs and 54 (30%) in military TCs. Most injuries were bullet-related (98%), predominantly due to urban violence (86%). The patients totalized 196 injuries including 103 (53%) soft-tissue injuries and 93 (47%) open fractures. Early total care was applied in 137 (70%) cases, and damage control orthopedics (DCO) in 59 (30%). The mean ISS was significantly higher in the DCO group. Early infection occurred in 20 cases, with 13 septic recurrences. At 25-month mean follow-up, bone union was achieved in 83%, with four persistent bone infections. Upper limb injuries more frequently involved nerves and temporary stabilization with splint. DCO was used more often in military TCs, but bone union and infection rates were comparable between groups. CONCLUSIONS: Despite variability in surgical strategies, outcomes were generally favorable. Low-energy ballistic limb injuries in civilian practice can often be managed according to standard open fracture principles; however, DCO may be warranted when patient-related factors (particularly associated injuries) or the clinical context require a staged approach. LEVEL OF EVIDENCE: IV; case series. Copyright © 2026 Elsevier Masson SAS. All rights reserved. DOI: 10.1016/j.otsr.2026.104701