The burden, management and treatment outcomes of gunshot-induced fractures of the forearm at a tertiary hospital in South Africa

OBJECTIVES: To assess the burden, management and outcomes of gunshot-induced extra-articular forearm fractures at a tertiary institution in the Western Cape of South Africa. METHODS: Design: Retrospective review Setting: Single centre, Level 1 trauma centre Patient Selection Criteria: Patients who presented with gunshot-induced extra-articular forearm fractures (OTA/AO 2R2 and/or 2U2) between January 2014 and December 2017 were included. Outcome Measures and Comparisons: Clinical examination and radiological review were used to assess for infection, neurovascular injury and union. RESULTS: Ninety-six patients (94% male, mean age 29±11) were included with 45 radius, 36 ulna and 15 both bone fractures. Associated injuries were identified in 53 (55.2%) patients and included 36 (37.5%) patients who sustained more than one gunshot injury, 24 (25%) patients who had associated nerve injuries and three (3%) patients who sustained arterial injuries. A total of 51 patients (53.1%) were treated operatively, with a median time to surgery of four (IQR 2- 8) days. One patient presented with a fracture-related infection 2 weeks after external fixation. Of the patients who followed up beyond 12 weeks (n=53, 55.2%), union occurred in 92.5% (n=49 of 53), 49 of these were treated operatively and 4 non-operatively Isolated radius fractures were malunited in a shortened position in 29.2% (n=12 of 41) patients, 7 of which were treated operatively. CONCLUSIONS: Gunshot-induced forearm fractures had a low infection rate, even without formal wound debridement or bullet removal. Isolated radius fractures commonly healed in a shortened position, highlighting the need for strategies to preserve length during treatment. Level of Evidence: IV