Zusammenfassung
Chirurgen an städtischen Kliniken werden auch in Europa zunehmend mit Schussverletzungen konfrontiert. Schussfrakturen mit geringer Weichteildestruktion können gemäß geschlossener Frakturlehre versorgt werden. Stabile Frakturen sind durch funktionelle Schienung, instabile durch primär definitive Stabilisierung behandelbar. Die prophylaktische Antibiotikatherapie bei geringem Weichteilschaden wird kontrovers diskutiert. Schussfrakturen mit schwerer Weichteilschädigung werden gemäß offener Frakturlehre behandelt. Ein adäquates Wunddébridement und eine Stabilisierung durch Fixateur externe werden empfohlen. Eine i.v. Antibiotikaprophylaxe ist obligat, die Durchführung einer prophylaktischen Fasziotomie häufig indiziert. Im Rahmen der definitiven osteosynthetischen Versorgung muss die Notwendigkeit von autologem Knochenersatz bedacht werden. Schussverletzungen des Gelenks werden als offene Gelenkverletzungen behandelt und bedürfen einer ausführlichen Spülung, eines Débridements mit Projektilentfernung sowie einer antibiotischen Therapie.
Abstract
The incidence of gunshot wounds is increasing also in Europe and surgeons in urban trauma centers are more frequently confronted with this type of injury. Since there is no established treatment algorithm for gunshot injuries to the extremities, the surgeon should rely on established soft tissue injury and fracture protocols. Gunshot fractures with minor soft tissue destruction should be treated as closed fractures. The treatment of choice for unstable fractures is early internal stabilization, whereas stable fractures may be treated by functional bracing. The administration of an antibiotic prophylaxis for fractures with minor soft tissue injury is controversial. Gunshot fractures with major soft tissue injury should be treated as open fractures. Debridement of nonviable tissue and external fixation are recommended. Prophylactic intravenous antibiotics are mandatory and prophylactic fasciotomy is often required. Upon definitive internal stabilization, bone grafting should be considered since gunshot fractures are usually associated with a high degree of comminution. Articular gunshot injuries are treated as open joint injuries and require irrigation, debridement, foreign body removal and antibiotic prophylaxis.
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Kobbe, P., Frink, M., Oberbeck, R. et al. Versorgungsstrategien bei Schussverletzungen der Extremität. Unfallchirurg 111, 247–255 (2008). https://doi.org/10.1007/s00113-008-1436-6
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DOI: https://doi.org/10.1007/s00113-008-1436-6
Schlüsselwörter
- Schussverletzung
- Geschlossene Frakturlehre
- Offene Frakturlehre
- Weichteilschädigung
- Antibiotikaprophylaxe