Evaluation of Treatment Results in Orthopaedic Firearm İnjuries: Review of 52 Cases

Background/Aims: The prevalence of firearm-related fractures (FAF) among civilians has increased in many countries. The management of these injuries is challenging for physicians. The aim of this study was to evaluate the outcome of patients treated for FAF. Methods: The study included adults treated in an orthopaedic clinic for fractures caused by civilian gunshot wounds to the large bones of the extremities between 2015 and 2020. The medical records of the patients were retrospectively reviewed in the two-centre study. Age, gender, fracture bone name, fracture type, fracture type, type of fracture, type of treatment, time to union, presence of permanent sequelae, presence of deep surface infection, presence of vascular injury, presence of nerve injury, presence of nonuniun-malunion, time to full function and follow-up period were analysed. Results: This study was performed in 52 cases with a mean age of 43 years. Fifty patients were male, and two were female. There were 22 tibia, 20 femur, 4 humerus, 4 ulna, and 2 radius fractures. In total, 11 patients were treated with conservative treatment, 15 patients with plate screws, 9 patients with intramedullary nails and 17 patients with external fixators. Permanent sequelae occurred in 13 (25%) patients following treatment. Seven (13.5%) infections emerged during the treatment phase of which four (7.7%) were superficial and three (5.8%) were deep infections. In cases treated with external fixator, infection occurred in five (29.4%) patients, four of them being superficial infections. The mean follow-up period for all patients was 37.5 (25-60) months. While the mean time to union was 6.6 (1.5-15) months in all patients, this time was shorter with a mean of 2.5 months in patients treated with conservative treatment(p<0.001). Conclusions: From admission to the emergency department to the finalisation of treatment, FAFs are challenging forensic cases for physicians. In addition to fractures, they may cause vascular, nerve and soft tissue injuries and may leave a high rate of sequelae. In addition to modern surgical techniques, conservative treatment is successfully used in appropriate cases.