Outcomes of fast-track primary internal fixation of open fractures in ballistic injuries – A single-center experience

Abstract

Background: Open fractures due to ballistic injuries (bullets and/or splinters due to grenade blasts) have increased in the last decade. Outcome of management of such injuries depends on various factors. Purpose of this study was to frame a management protocol for primary internal fixation of such fractures without significant complications. Materials and Methods: 105 patients (117 fractures) of ballistic injuries evacuated to the trauma care center of this hospital from July 2018 to July 2019 were enrolled. After initial evaluation and optimal resuscitation, patients were considered for primary internal fixation of the fractures followed by multidepartmental rehabilitation involving a physiotherapist, a psychiatrist, and a psychotherapist. Follow-up was done at 3 months, 6 months, and 1 year after the surgery. Results: 74 fractures were due to gunshot-related injuries and 43 due to splinters from grenade blasts. Average interval between time of injury and surgery was 5.68 h. Seventeen patients required repeat debridement after initial surgery, and the subsequent wound healing was uneventful. All fractures united except 15 patients who underwent bone grafting for aseptic nonunion (6–9 months after index surgery). Only six patients were followed telephonically, else there was no loss to follow-up. The study did not encounter any mortality or infection. Conclusions: Open fractures occurring due to ballistic injuries pose a unique challenge in management. Fast-track evaluation and urgent management of the fractures by careful wound debridement and primary internal fixation have shown excellent results, with absolute zero infection rate in 1-year follow-up.

Keywords

• ballistic injuries
• open fractures
• primary internal fixation