ABSTRACT
The purpose of this multicenter retrospective chart review was to describe demographics,
fracture and wound characteristics, and treatments for foot and/or ankle fractures
caused by gunshot wounds (GSWs) and identify factors that increase risk of infection
in adults treated at 5 urban level 1 trauma centers in South and Midwest regions of
the United States. A total of 244 patients sustained GSW-related fractures of the
foot/ankle during 2007-2017, of whom 179 had ≥30 days of follow-up data after the
initial injury. Most patients were male (95.1%; 232/244) with an average age of 31.2
years. On average, patients sustained 1.3 GSWs (range 1-5) to the foot/ankle. Most
GSWs were categorized as low energy (85.1%; 171/201) and the majority (58.2%; 142/244)
had retained bullet fragments. Antibiotics were administered at initial presentation
to 78.7% (192/244) of patients and 41.8% (102/244) were managed operatively at the
time of initial injury. Nerve injury, vascular injury, and infection were documented
in, respectively, 8.6% (21/243), 6.6% (16/243), and 17.2% (42/244) of all cases. Multivariable
analysis revealed that high-energy injuries and retained bullet fragments increased
the risk of infection by 3-fold (odds ratio 3.09, 95% confidence interval 1.16-8.27,
p = .025) and 3.5-fold (OR 3.48, 95% CI1.40-8.67; p = .008), respectively. Side of injury, primary injury region, and vascular injury
were not significant predictors of infection risk. Further research should examine
whether retained bullet fragments are directly associated with infection risk and
support the development of guidelines regarding the management of patients with GSW-related
fractures to the ankle/foot.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: March 31, 2022
Footnotes
Financial Disclosures: None reported.
Conflict of Interest: None reported.
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