Clinical and radiological outcomes of gunshot-induced femur fractures: a comparative study of monolateral external fixators and hybrid advanced ilizarov method

Abstract

Aims: Clinical and radiological outcomes, complication rates, and 10-year follow-up results of comminuted femoral open fractures resulting from firearm injuries were evaluated by comparing the Hybrid Advanced Ilizarov method (HAIM) and monolateral external fixator (MEF) of the limb reconstruction system (LRS) for treatment. Methods: Nineteen patients (18 males, 1 female) treated with HAIM and 14 male patients treated with MEF-LRS for femoral comminuted open fractures due to firearm injuries were retrospectively analyzed. Complication rates, pin tract and deep infection rates, time to union, and the need for secondary surgeries were assessed. The Tegner activity score and Short Form-36 (SF-36) were used for comparative evaluation of functional and radiological outcomes and comfort levels with the fixator. Results: There were no significant differences between the groups in terms of age, gender, follow-up duration, time to union, union rate, delayed union, or deep infection. No infections were detected in either group that required a change in the fixation method. There were no significant differences in radiological and functional outcomes between the groups. Significant differences were observed in terms of pin tract infections between the groups. The comfort level of MEF-LRS patients was significantly higher than that of HAIM patients. Conclusion: In the treatment of femoral fractures due to firearm injuries in early and long-term follow-ups, similar complication rates and functional outcomes were achieved for both MEF-LRS and HAIM methods. When considering external fixator preference, MEF-LRS is a better alternative, with a lower rate of pin tract infections and higher patient comfort level.