Abstract
Abstract
Purpose
The purpose of this study was to report our 5 years surgical experience and the rate of neurovascular injury following gunshot fractures of the distal humerus in a in level-1 Trauma Centre in South Africa.
Methods
A retrospective case series of 25 consecutive adult gunshot injuries to the distal humerus. Demographic and injury data were extracted from clinical case notes and electronic operative records. Imaging archives were used to classify fractures according to the AO/OTA classification.
Results
Twenty-five male patients, with mean age of 32-years-old, sustained gunshot injuries to the distal humerus. Eleven patients had multiple gunshots. Forty-four percent of patients underwent Computed Tomography Angiography (CTA), 20% had confirmed brachial artery injury. Limbs with vascular injury were salvaged with arterial repair and external fixation. Fractures were extra-articular in 20 cases (80%). Nineteen fractures were classified as highly comminuted. Nerve injuries occurred in 52% and were all managed expectantly. Only 32% of patients attended follow-up beyond 3 months.
Conclusions
These are rare challenging injuries with high rates of neurovascular damage. This demographic of patients is poorly compliant with follow up highlighting the need for high-quality early care. Brachial artery injury should be excluded with CTA and can be managed with arterial repair and external fixation. All fractures in this series were surgically managed with conventional anatomical plate and screw fixation techniques. For nerve injury, we advocate expectant management.
Level of evidence
IV.
Publisher
Springer Science and Business Media LLC
Subject
Orthopedics and Sports Medicine,Surgery
Reference17 articles.
1. Ibrahim DA, Swenson A, Sassoon A, Fernando ND (2017) Classifications in brief: the tscherne classification of soft tissue injury. Clin Orthop Relat Res 475(2):560–564. https://doi.org/10.1007/s11999-016-4980-3
2. Bongard FS, Klein SR (1989) The problem of vascular shotgun injuries: diagnostic and management strategy. Ann Vasc Surg 3(4):299–303
3. Paryavi E, Pensy RA, Higgins TF, Chia B, Eglseder WA (2014) Salvage of upper extremities with humeral fracture and associated brachial artery injury. Injury 45(12):1870–1875. https://doi.org/10.1016/j.injury.2014.08.038
4. Abghari M, Monroy A, Schubl S, Davidovitch R, Egol K (2015) Outcomes following low-energy civilian gunshot wound trauma to the lower extremities: results of a standard protocol at an urban trauma center. Iowa Orthop J 35:65–69
5. Johnson EC, Strauss E (2003) Recent advances in the treatment of gunshot fractures of the humeral shaft. Clin Orthop Relat Res 408:126–132. https://doi.org/10.1097/00003086-200303000-00015