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Khak M, Shariyate MJ, Villarreal-Espinosa JB, Kheir N, Momenzadeh K, McNichol M, Appleton P, Wixted JJ, Rodriguez EK, Nazarian A. Antibiotic prophylaxis following low-velocity gunshot fractures: an updated review. INTERNATIONAL ORTHOPAEDICS 2024; 48:37-47. [PMID: 38078940 DOI: 10.1007/s00264-023-06052-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Low-velocity gunshot fractures (LVGFs) are a common type of gunshot-induced trauma with the potential for complications such as infection and osteomyelitis. The effectiveness of antibiotic therapy in LVGFs remains uncertain, leading to ongoing debate about the appropriate treatment. In this review, we evaluate recent updates on the current understanding of antibiotic therapy in LVGFs, how previous studies have investigated the use of antibiotics in LVGFs, and the current state of institutional policies and protocols for treating LVGFs with antibiotics. METHODS We conducted a review of PubMed, Embase, and Web of Science databases to identify studies that investigated the use of antibiotics in LVGFs after the last review in 2013. Due to the lack of quantitative clinical trial studies, we employed a narrative synthesis approach to analyze and present the findings from the included primary studies. We categorized the outcomes based on the anatomical location of the LVGFs. RESULTS After evaluating 67 publications with the necessary qualifications out of 578 abstracts, 17 articles were included. The sample size of the studies ranged from 22 to 252 patients. The antibiotics used in the studies varied, and the follow-up period ranged from three months to ten years. The included studies investigated the use of antibiotics in treating LVGFs at various anatomic locations, including the humerus, forearm, hand and wrist, hip, femur, tibia, and foot and ankle. CONCLUSION Our study provides updated evidence for the use of antibiotics in LVGFs and highlights the need for further research to establish evidence-based guidelines. We also highlight the lack of institutional policies for treating LVGFs and the heterogeneity in treatments among institutions with established protocols. A single-dose antibiotic approach could be cost-effective for patients with non-operatively treated LVGFs. We suggest that a national or international registry for gunshot injuries, antibiotics, and infections could serve as a valuable resource for collecting and analyzing data related to these important healthcare issues.
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Affiliation(s)
- Mohammad Khak
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, RN123A, Boston, MA, 02215, USA
| | - Mohammad Javad Shariyate
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, RN123A, Boston, MA, 02215, USA
| | - Juan Bernardo Villarreal-Espinosa
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, RN123A, Boston, MA, 02215, USA
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, RN123A, Boston, MA, 02215, USA
| | - Kaveh Momenzadeh
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, RN123A, Boston, MA, 02215, USA
| | - Megan McNichol
- Knowledge Services, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Paul Appleton
- J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - John J Wixted
- J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Edward K Rodriguez
- J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, RN123A, Boston, MA, 02215, USA.
- Department of Orthopaedic Surgery, Yerevan State University, Yerevan, Armenia.
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Aljasim O, Vahabi A, Öztürk AM, Aktuğlu K. Factors affecting return to work time and functional outcome after low-velocity gunshot injuries related to foot in civilian population. Injury 2023; 54:111149. [PMID: 37923675 DOI: 10.1016/j.injury.2023.111149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Purpose of this study was to identify factors affecting return to work time and functional outcomes after low-velocity gunshot injuries related to foot. Related complications are also analyzed. METHOD This study conducted as retrospective cohort study in tertiary care university hospital. Data on 26 patients obtained through retrospective database search. Type of causing weapon, anatomic location of wound, wound type according to Gustilo Anderson classification, extend of damage regarding injured structures, extend of soft tissue damage, duration of hospital stay, need of reconstructive surgery, return-to-work time, follow-up period and functional scores at final follow-up were recorded. Factors affecting functional outcome and return-to-work time were analyzed. RESULTS Total of 12 patients (46.2 %) experienced complications, with eight being deep soft tissue infections. The mean MFS score for the study group was 77.27 (±11.82). The mean MFS for the pistol group was 83.46 (±6.90), extent of soft tissue damage was an independent risk factor (OR 10.67, 95 % CI 1.70-66.72, p = 0.011) for poor outcomes. On average, patients took 10.12 months (±7.59) to return to work, the type of gun used was an independent variable associated with delayed return to work (OR 144, 95 % CI 8.04-2578.09, p = 0.011). CONCLUSION Gunshot injuries related to foot can lead to a high rate of complications, loss of workdays, and permanent functional losses. Therefore, it is crucial to develop appropriate treatment plans and manage inevitable complications in these injuries. LEVEL OF EVIDENCE Level IV, Case series.
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Affiliation(s)
- Omar Aljasim
- Ege University School of Medicine, Department of Orthopedics and Traumatology, Izmir, Turkey
| | - Arman Vahabi
- Ege University School of Medicine, Department of Orthopedics and Traumatology, Izmir, Turkey
| | - Anıl Murat Öztürk
- Ege University School of Medicine, Department of Orthopedics and Traumatology, Izmir, Turkey.
| | - Kemal Aktuğlu
- Ege University School of Medicine, Department of Orthopedics and Traumatology, Izmir, Turkey
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