Management of gunshot fractures to the extremities - A narrative review

To review the literature regarding antibiotic protocols, indications for formal irrigation, timing of debridement, and outcomes following fixation for low and high velocity gunshot fractures. The limitations in the literature will also be discussed. Most countries are experiencing increasing rates of gunshot fractures. Injuries from high powered firearms are increasingly being seen in civilian practice hence civilian trauma surgeons are forced to become more familiar in managing these injuries. This article attempts to assist in formulating a treatment protocol for managing gunshot fractures. A narrative review was conducted utilising numerous research portals namely PubMed. Search terms included low versus high velocity gunshot injuries, antibiotics and debridement in gunshot fractures and gunshot to extremities. The literature lacks standardisation regarding treatment protocols for gunshot fractures regardless of the injury site. There are several challenges in comparing superficial and deep infection rates and non-union rates. Data is often retrospective with inadequate sample sizes. Modern studies suggests that infection and non-union complications are more common than earlier data suggests. Recent studies suggest a more aggressive approach to managing these injuries: intravenous antibiotics, formal irrigation, early debridement and an increasing trend towards early internal fixation. With increasing use of high powered weapons causing civilian injuries, newer protocols guided by better powered randomised controlled studies are now needed to analyse modern day gunshot fractures.