Total hip replacement after gunshot hip injuries: a severity-based clinical framework-a single-centre experience.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of orthopaedic department of Cairo University. Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent to publish: Patient gave written informed consent for their personal or clinical details along with any identifying images to be published in this study. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable. 17. Injury. 2020 Nov;51(11):2601-2611. doi: 10.1016/j.injury.2020.08.028. Epub 2020 Aug 24. Management of upper extremity war injuries in the subacute period: A review of 62 cases. Sari A(1), Ozcelik IB(2), Bayirli D(3), Ayik O(4), Mert M(5), Ercin BS(6), Baki H(5), Mersa B(2). Author information: (1)Department of Orthopedics and Traumatology, Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey. Electronic address: drortopedist@yahoo.com. (2)Istanbul Hand Surgery and Microsurgery Group, Yeni Yüzyıl University, Hand and Upper Extremity Surgery Unit, Gaziosmanpaşa Private Hospital, Nisantasi University Vocational High School, Istanbul, Turkey. (3)Infectious Diseases Clinic, Gaziosmanpaşa Private Hospital, Yeni Yüzyıl University, Istanbul, Turkey. (4)Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. (5)Orthopedics and Traumatology Clinic, Gaziosmanpaşa Private Hospital, Yeni Yüzyıl University, Istanbul, Turkey. (6)Mikroplast Hand Surgery and Microsurgery Group, Plastic and Reconstructive Surgery Clinic, Gebze Medical Park Hospital, Kocaeli, Turkey. OBJECTIVE: In this study, we aimed to describe the relationship between the localization of rarely seen upper extremity war injuries and their complications in the subacute period, and define our preferences for surgery and antibiotic use. METHODS: Patients with an upper extremity war injury who presented to our institution between 2015 and 2018 were retrospectively evaluated. Data regarding demographics, time between injury and presentation, location of injury, type of damage, complications, treatment methods, infection rates and antibiotic use were recorded. Tissue defects, fracture fixation, neurovascular damage, infection development and treatment approaches were analyzed. RESULTS: Sixty-two male patients with isolated upper extremity injuries (mean age: 31.66 ± 8.28 years) were included in the study. The average time between trauma and hospitalization was 14 days. The mean hematocrit (Hct) level at presentation was 36.3 ± 6.8%. Patients had been followed up for an average period of 95.6 ± 32.1 days. Twenty-nine patients (46.8%) had nerve injury, eight (12.9%) had arterial injury that required repair, and 23 had infection (37.1%), of which five developed osteomyelitis. Infection was polymicrobial in nine cases and monobacterial in 14. A positive correlation was found between the presence of fracture and nerve injury (p = 0.013). The frequency of nerve injuries due to gunshot wounds was higher in the mid-section and lower part of the arms and in the proximal forearm when compared to other regions (p = 0.011). The infection rates were significantly higher in patients with fractures (p = 0.033). The mean hematocrit (Hct) level at presentation of the patients with infection (32.1 ± 6.3%) was significantly lower than that of those who did not have infection (38.8 ± 5.9%) (p