Abstract
BackgroundIn gunshot and shell fragment injuries to the hip joint, orthopedic intervention includes wound assessment and care, osteosynthesis of fractures, and avoiding of infection and osteoarthritis. Individuals injured in the Syrian civil war were frequently transferred to the authors’ institution in neighboring city. Orthopedic trauma exposures were determined in approximately 30% of these patients. The aim of this study was to evaluate the outcomes of the patients with secondary hip arthritis due to prior gunshot and shell fragment (shrapnel) injuries who underwent primary total hip arthroplasty.MethodsThis retrospective study reviewed 26 patients (24 males, 2 females) who underwent hip arthroplasty due to prior gunshot and shell fragment injuries from November 2013 to January 2019. For all patients, the Harris Hip Score (HHS) was evaluated preoperatively and after surgery.ResultsMean age was 31.5 (range, 19–48) years. The mean preoperative HHS was 52.95 points, and the mean postoperative HHS was 79.92 points at the final follow-up after surgery. Patients with shell fragment injuries to the hip joint had higher infection rates, but it is not statistically significant.ConclusionsAn anatomic reduction of the fracture may not be possible in these cases as a result of significant bone and/or cartilage loss. Total hip arthroplasty can be done after gunshot- and shell fragment-related posttraumatic arthritis. It is an effective treatment choice to reduce pain and improve function, but the surgeon must be very careful because of high rate of infection.
Highlights
In gunshot and shell fragment injuries to the hip joint, orthopedic intervention includes wound assessment and care, osteosynthesis of fractures, and avoiding of infection and osteoarthritis
A bullet that passes into the hip joint rarely causes an infection, but a transabdominal trajectory that subsequently enters the hip joint indicates a high risk for infection after total hip arthroplasty [10]
There was no statistically significant difference according to age, sex, preoperative Harris Hip Score (HHS) (P = 0.354), and postoperative HHS (P = 0.396) between the two groups
Summary
In gunshot and shell fragment injuries to the hip joint, orthopedic intervention includes wound assessment and care, osteosynthesis of fractures, and avoiding of infection and osteoarthritis. The aim of this study was to evaluate the outcomes of the patients with secondary hip arthritis due to prior gunshot and shell fragment (shrapnel) injuries who underwent primary total hip arthroplasty. Özden et al Journal of Orthopaedic Surgery and Research (2020) 15:464 They are different from bullets that produce high-energy transfer to the tissue by creating a temporary cavitation [7]. While the number of gunshot and shell fragment wounds increases, orthopedic surgeons are experienced with more penetrating musculoskeletal injuries. Orthopedic intervention includes wound assessment and care, osteosynthesis of fractures, and avoiding of infection and osteoarthritis. In the non-symptomatic patient, bullets and shell fragments can be left in place. A bullet that passes into the hip joint rarely causes an infection, but a transabdominal trajectory that subsequently enters the hip joint indicates a high risk for infection after total hip arthroplasty [10]
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