Ballistic Injuries to the Foot and Ankle: Antibiotic Administration and Infection Rate

Abstract

Category: Trauma; Ankle; Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: Although frequently non-fatal, ballistic injuries to the foot and ankle can lead to significant morbidity and functional impairment. General management principles are often employed, however there is a paucity of data related outcomes following ballistic injury to the foot and ankle. Methods: A retrospective chart review of inpatients who sustained a ballistic injury to the foot and ankle was performed at a single level one trauma institution from 2014 to 2019. A total of 64 patients were identified. Each chart was reviewed for demographics, foot and ankle injury sustained, associated non-orthopaedic injuries, antibiotics received, procedures undergone, and complications documented. Results: The patients were more frequently male (M:F, 11.8:1) with a mean age of 31.2 years (18-75). Fifty-two (81.3%) patients received antibiotics, all of which covered for gram positive organisms. Twelve of these patients also received coverage for gram- negative organisms. Two (3.1%) patients developed a documented infection. One patient who received gram positive antibiotic coverage sustained 1 fracture, underwent bedside bullet removal, and developed a cellulitis that responded to oral antibiotics. The other patient received both gram positive and gram negative coverage, sustained 6 fractures in the foot with extensive soft tissue injury, underwent operative debridement, and ultimately required transmetatarsal amputation due to infection/osteomyelitis. Conclusion: Ballistic injuries to the foot and ankle are common injuries encountered by orthopaedists in an urban setting. The infection rate (3.1%) in our series is low and comparable to infection rates seen after ballistic injury to the hand. Negative outcomes after ballistic injury are associated with multiple fractures and soft tissue compromise. We advocate for early antibiotic administration and a high index of suspicion for infection in these cases.