Abstract：
OBJECTIVE: To examine the effects of RBF (Retained Bullet Fragment) removal at the time of long bone fixation on FRI (fracture related infection) rates in low energy GSI (Gunshot Injury) related fractures.
METHODS: Retrospective Cohort Study SETTING: Level 1 Academic Trauma Center INTERVENTION: Retrospective review of the impact of RBFs on the risk of FRI when employing internal fixation in low energy GSI (Gunshot Injury) related fractures. In situations where the injury pattern requires surgical fixation, the question arises as to whether or not the RBFs need to be removed to prevent FRI.
METHODS: Whether or not the RBFs removed in our patient population prevented short- and long-term fracture related infection after low-energy gunshot injury (FRI-LGI).
RESULTS: Of the 2,136 GSI related fractures, 131 patients met inclusion criteria, 81 patients underwent removal (R) of RBFs at the time of internal fixation while 50 patients did not undergo any removal (NR) at time of internal fixation. Among the patients who underwent surgical intervention, (Open Reduction Internal Fixation) ORIF was performed in 55 cases (R: 39; NR: 16), and (Intramedullary Nail) IMN was performed in 76 cases (R: 42; NR: 34). The overall rate of deep FRI-LGI was 6.9 % of the 131-patient cohort. We found that removal of RBFs had a statistically significant impact on the rate of deep FRI-LGI when compared to the NR group (p = 0.031). In the RBF removal group, only two patients (2.4 %) developed deep FRI-LGIs, whereas in the NR group, seven patients (14.0 %) developed deep FRI-LGIs. The incidence of early FRI-LGI was higher in the NR group (median 0.6 months) compared to the R group, which was associated with late FRI-LGIs (median 10.1 months) when they occurred.
CONCLUSIONS: In our study population, we found a statistically significantly increased incidence of deep and early FRI-LGI when RBFs are not removed at the time of extra-articular long bone internal fixation. The presence of retained bullet fragments following internal fixation may pose a risk factor for future development of deep FRI-LGI. We believe a surgeon should use their best judgment as to whether a RBF can safely be removed at the time of long bone fixation. Based on our findings, if safely permitted, RBF removal should be considered at the time of GSI long bone fixation resulting from low energy hand gun injuries.
METHODS: Retrospective Cohort Study SETTING: Level 1 Academic Trauma Center INTERVENTION: Retrospective review of the impact of RBFs on the risk of FRI when employing internal fixation in low energy GSI (Gunshot Injury) related fractures. In situations where the injury pattern requires surgical fixation, the question arises as to whether or not the RBFs need to be removed to prevent FRI.
METHODS: Whether or not the RBFs removed in our patient population prevented short- and long-term fracture related infection after low-energy gunshot injury (FRI-LGI).
RESULTS: Of the 2,136 GSI related fractures, 131 patients met inclusion criteria, 81 patients underwent removal (R) of RBFs at the time of internal fixation while 50 patients did not undergo any removal (NR) at time of internal fixation. Among the patients who underwent surgical intervention, (Open Reduction Internal Fixation) ORIF was performed in 55 cases (R: 39; NR: 16), and (Intramedullary Nail) IMN was performed in 76 cases (R: 42; NR: 34). The overall rate of deep FRI-LGI was 6.9 % of the 131-patient cohort. We found that removal of RBFs had a statistically significant impact on the rate of deep FRI-LGI when compared to the NR group (p = 0.031). In the RBF removal group, only two patients (2.4 %) developed deep FRI-LGIs, whereas in the NR group, seven patients (14.0 %) developed deep FRI-LGIs. The incidence of early FRI-LGI was higher in the NR group (median 0.6 months) compared to the R group, which was associated with late FRI-LGIs (median 10.1 months) when they occurred.
CONCLUSIONS: In our study population, we found a statistically significantly increased incidence of deep and early FRI-LGI when RBFs are not removed at the time of extra-articular long bone internal fixation. The presence of retained bullet fragments following internal fixation may pose a risk factor for future development of deep FRI-LGI. We believe a surgeon should use their best judgment as to whether a RBF can safely be removed at the time of long bone fixation. Based on our findings, if safely permitted, RBF removal should be considered at the time of GSI long bone fixation resulting from low energy hand gun injuries.
摘要：
目的：观察长骨固定时RBF（保留子弹碎片）去除对低能量GSI（枪伤）相关骨折FRI（骨折相关感染）发生率的影响。
方法：回顾性队列研究设置：1级学术创伤中心干预：回顾性回顾在低能量GSI（枪伤）相关骨折中采用内固定时，RBFs对FRI风险的影响。在损伤模式需要手术固定的情况下，问题是，是否需要删除RBF来防止FRI。
方法：在我们的患者人群中，是否切除RBF可以预防低能量枪伤（FRI-LGI）后的短期和长期骨折相关感染。
结果：在2,136例GSI相关骨折中，131例患者符合纳入标准，81例患者在内固定时进行了RBFs的去除（R），而50例患者在内固定时未进行任何去除（NR）。在接受手术干预的患者中，（切开复位内固定）55例行ORIF（R：39；NR：16），（髓内钉）IMN76例（R：42；NR：34）。深层FRI-LGI的总发生率为131名患者队列的6.9%。我们发现，与NR组相比，去除RBFs对深层FRI-LGI的发生率具有统计学上的显着影响（p=0.031）。在RBF移除组中，只有两名患者（2.4％）发展深FRI-LGIs，而在NR组中，7例患者（14.0%）发展为深FRI-LGIs。与R组相比，NR组早期FRI-LGI的发生率较高（中位数0.6个月），发生时与晚期FRI-LGIs（中位数10.1个月）相关。
结论：在我们的研究人群中，我们发现,当在关节外长骨内固定时不去除RBFs时,深部和早期FRI-LGI的发生率在统计学上显著增加.内固定后残留的子弹碎片的存在可能是深FRI-LGI未来发展的危险因素。我们认为，外科医生应该对长骨固定时是否可以安全地移除RBF做出最佳判断。根据我们的发现,如果安全允许，在低能量手枪伤导致的GSI长骨固定时，应考虑去除RBF。
方法：回顾性队列研究设置：1级学术创伤中心干预：回顾性回顾在低能量GSI（枪伤）相关骨折中采用内固定时，RBFs对FRI风险的影响。在损伤模式需要手术固定的情况下，问题是，是否需要删除RBF来防止FRI。
方法：在我们的患者人群中，是否切除RBF可以预防低能量枪伤（FRI-LGI）后的短期和长期骨折相关感染。
结果：在2,136例GSI相关骨折中，131例患者符合纳入标准，81例患者在内固定时进行了RBFs的去除（R），而50例患者在内固定时未进行任何去除（NR）。在接受手术干预的患者中，（切开复位内固定）55例行ORIF（R：39；NR：16），（髓内钉）IMN76例（R：42；NR：34）。深层FRI-LGI的总发生率为131名患者队列的6.9%。我们发现，与NR组相比，去除RBFs对深层FRI-LGI的发生率具有统计学上的显着影响（p=0.031）。在RBF移除组中，只有两名患者（2.4％）发展深FRI-LGIs，而在NR组中，7例患者（14.0%）发展为深FRI-LGIs。与R组相比，NR组早期FRI-LGI的发生率较高（中位数0.6个月），发生时与晚期FRI-LGIs（中位数10.1个月）相关。
结论：在我们的研究人群中，我们发现,当在关节外长骨内固定时不去除RBFs时,深部和早期FRI-LGI的发生率在统计学上显著增加.内固定后残留的子弹碎片的存在可能是深FRI-LGI未来发展的危险因素。我们认为，外科医生应该对长骨固定时是否可以安全地移除RBF做出最佳判断。根据我们的发现,如果安全允许，在低能量手枪伤导致的GSI长骨固定时，应考虑去除RBF。
