Divya Jeyasingh, David Campbell, Christopher Wedwick, Niloofar Dehghan
{"title":"低能量射击胫骨骨折感染和再手术风险升高的比较分析。","authors":"Divya Jeyasingh, David Campbell, Christopher Wedwick, Niloofar Dehghan","doi":"10.1097/BOT.0000000000002995","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the deep infection and reoperation rates associated with low-energy gunshot wound (LE-GSW) tibial shaft fractures and compare outcomes to fractures caused by blunt-force mechanisms and to analyze the microbial profile of infections in these cases.</p><p><strong>Methods: </strong>Design : Retrospective cohort study.</p><p><strong>Setting: </strong>Three Level 1 trauma centers in a large urban health system from 2014 to 2024.</p><p><strong>Patient selection criteria: </strong>Included were patients aged 16-65 years with tibial shaft fractures (OTA/AO 41A2-3, 42A-C, and 43A) treated with intramedullary nails (IMN) following LE-GSW or blunt-force mechanisms. Exclusions were pre-existing infections, high-velocity gunshot wounds, less than 6 weeks of follow-up, or delayed presentation (greater than 24 hours).</p><p><strong>Outcome measures and comparisons: </strong>Primary outcomes included deep infection and unplanned reoperations. Patients were categorized into closed fractures, LE-GSWs, Type I/II, and Type III open fractures. Data between these categories were compared using chi-square, Fisher's exact, and ANOVA with multivariable logistic regression.</p><p><strong>Results: </strong>Included were 195 patients (mean age 37.6 years, range 17-65; M:F ratio 136:59). Fractures were closed (n=68), Type I/II (n=55), Type III (n=37), and LE-GSWs (n=35). LE-GSWs had significantly higher deep infection (34.3%) and reoperation rates (57.1%) compared to closed fractures (1.5% and 13.2%, respectively, p<0.001). Type III infection rates were 16.2%. Multivariable analysis confirmed LE-GSWs as a significant risk factor for both infection (OR 4.26, p=0.003) and reoperations (OR 3.51, p=0.002). Infections in LE-GSW fractures were predominantly polymicrobial and Gram-positive.</p><p><strong>Conclusions: </strong>LE-GSW tibial fractures were associated with high rates of deep infection and reoperation with infection rates comparable to those of Type III open fractures. Treatment options such as broader prophylaxis or local antibiotic treatments should be considered in their initial management.</p><p><strong>Level of evidence: </strong>Level III - Retrospective Cohort Study.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Elevated Risk of Infection and Reoperation in Low-Energy Gunshot Tibial Fractures: A Comparative Analysis.\",\"authors\":\"Divya Jeyasingh, David Campbell, Christopher Wedwick, Niloofar Dehghan\",\"doi\":\"10.1097/BOT.0000000000002995\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To investigate the deep infection and reoperation rates associated with low-energy gunshot wound (LE-GSW) tibial shaft fractures and compare outcomes to fractures caused by blunt-force mechanisms and to analyze the microbial profile of infections in these cases.</p><p><strong>Methods: </strong>Design : Retrospective cohort study.</p><p><strong>Setting: </strong>Three Level 1 trauma centers in a large urban health system from 2014 to 2024.</p><p><strong>Patient selection criteria: </strong>Included were patients aged 16-65 years with tibial shaft fractures (OTA/AO 41A2-3, 42A-C, and 43A) treated with intramedullary nails (IMN) following LE-GSW or blunt-force mechanisms. Exclusions were pre-existing infections, high-velocity gunshot wounds, less than 6 weeks of follow-up, or delayed presentation (greater than 24 hours).</p><p><strong>Outcome measures and comparisons: </strong>Primary outcomes included deep infection and unplanned reoperations. Patients were categorized into closed fractures, LE-GSWs, Type I/II, and Type III open fractures. Data between these categories were compared using chi-square, Fisher's exact, and ANOVA with multivariable logistic regression.</p><p><strong>Results: </strong>Included were 195 patients (mean age 37.6 years, range 17-65; M:F ratio 136:59). Fractures were closed (n=68), Type I/II (n=55), Type III (n=37), and LE-GSWs (n=35). LE-GSWs had significantly higher deep infection (34.3%) and reoperation rates (57.1%) compared to closed fractures (1.5% and 13.2%, respectively, p<0.001). Type III infection rates were 16.2%. Multivariable analysis confirmed LE-GSWs as a significant risk factor for both infection (OR 4.26, p=0.003) and reoperations (OR 3.51, p=0.002). Infections in LE-GSW fractures were predominantly polymicrobial and Gram-positive.</p><p><strong>Conclusions: </strong>LE-GSW tibial fractures were associated with high rates of deep infection and reoperation with infection rates comparable to those of Type III open fractures. Treatment options such as broader prophylaxis or local antibiotic treatments should be considered in their initial management.</p><p><strong>Level of evidence: </strong>Level III - Retrospective Cohort Study.</p>\",\"PeriodicalId\":16644,\"journal\":{\"name\":\"Journal of Orthopaedic Trauma\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-04-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Orthopaedic Trauma\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BOT.0000000000002995\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Trauma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BOT.0000000000002995","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Elevated Risk of Infection and Reoperation in Low-Energy Gunshot Tibial Fractures: A Comparative Analysis.
Objectives: To investigate the deep infection and reoperation rates associated with low-energy gunshot wound (LE-GSW) tibial shaft fractures and compare outcomes to fractures caused by blunt-force mechanisms and to analyze the microbial profile of infections in these cases.
Methods: Design : Retrospective cohort study.
Setting: Three Level 1 trauma centers in a large urban health system from 2014 to 2024.
Patient selection criteria: Included were patients aged 16-65 years with tibial shaft fractures (OTA/AO 41A2-3, 42A-C, and 43A) treated with intramedullary nails (IMN) following LE-GSW or blunt-force mechanisms. Exclusions were pre-existing infections, high-velocity gunshot wounds, less than 6 weeks of follow-up, or delayed presentation (greater than 24 hours).
Outcome measures and comparisons: Primary outcomes included deep infection and unplanned reoperations. Patients were categorized into closed fractures, LE-GSWs, Type I/II, and Type III open fractures. Data between these categories were compared using chi-square, Fisher's exact, and ANOVA with multivariable logistic regression.
Results: Included were 195 patients (mean age 37.6 years, range 17-65; M:F ratio 136:59). Fractures were closed (n=68), Type I/II (n=55), Type III (n=37), and LE-GSWs (n=35). LE-GSWs had significantly higher deep infection (34.3%) and reoperation rates (57.1%) compared to closed fractures (1.5% and 13.2%, respectively, p<0.001). Type III infection rates were 16.2%. Multivariable analysis confirmed LE-GSWs as a significant risk factor for both infection (OR 4.26, p=0.003) and reoperations (OR 3.51, p=0.002). Infections in LE-GSW fractures were predominantly polymicrobial and Gram-positive.
Conclusions: LE-GSW tibial fractures were associated with high rates of deep infection and reoperation with infection rates comparable to those of Type III open fractures. Treatment options such as broader prophylaxis or local antibiotic treatments should be considered in their initial management.
Level of evidence: Level III - Retrospective Cohort Study.
期刊介绍：
Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
