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Primary internal fixation in open fractures of tibia following high-velocity gunshot wounds: a single-centre experience

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Abstract

Purpose

High-velocity gunshot fractures are primarily a domain of military medicine. Traditionally, the management of choice for these injuries has been an external fixation. However, we present a series of high-velocity gunshot fractures of tibia managed with primary internal fixation.

Methods

Twenty-nine cases of high-velocity gunshot tibial fractures presenting within six hours of trauma were taken up for primary internal fixation and followed up at two months, four months, six months and one year including telephonic follow-up for five patients.

Results

Cases with various grades of open fracture were taken up for debridement and primary internal fixation within a mean period of three hours 40 minutes post trauma. Twenty-two cases were managed with unreamed interlocking nail and fixation was done with plate in seven cases. Five cases developed early superficial infection and four developed deep infection. All tibia united; however, secondary procedures were required in six cases to achieve union. One patient developed infected non-union which was managed with rail fixator. One patient was left with chronic discharging sinus.

Conclusions

High-velocity gunshot wounds of leg present special challenge to the orthopaedic surgeons. Timely intervention, through debridement and meticulous soft-tissue handling, can give good results with primary internal fixation. Our results are comparable to open fractures of tibia due to other causes and with other studies using external fixation. Further randomised controlled trials are needed to substantiate our findings.

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Authors and Affiliations

  1. Joint Replacement Centre, Army Hospital (R&R), New Delhi, 110010, India

    Jai Prakash Khatri

  2. Department of Orthopaedics, 92 Base Hospital, Srinagar, Jammu & Kashmir, 190004, India

    Manoj Kumar

  3. Department of Orthopaedics, AFMC, Pune, 411010, India

    Chander Mohan Singh

Authors
  1. Jai Prakash Khatri
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  2. Manoj Kumar
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  3. Chander Mohan Singh
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Correspondence to Manoj Kumar.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Khatri, J.P., Kumar, M. & Singh, C.M. Primary internal fixation in open fractures of tibia following high-velocity gunshot wounds: a single-centre experience. International Orthopaedics (SICOT) 44, 685–691 (2020). https://doi.org/10.1007/s00264-019-04387-x

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  • DOI: https://doi.org/10.1007/s00264-019-04387-x

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