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Orthopaedics & Traumatology: Surgery & Research
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le vendredi 11 janvier 2019
Doi : 10.1016/j.otsr.2018.11.002
Received : 24 May 2018 ;  accepted : 13 November 2018
Treating fractures in upper limb gunshot injuries: The Cape Town experience

Esmee Wilhelmina Maria Engelmann , Stephen Roche, Sithombo Maqungo, DuPreez Naude, Michael Held
 Groote Schuur Hospital, Cape Town, South Africa 

Corresponding author. Groote Schuur Hospital, Orthopaedic Surgery, Old Main Building, Main Rd, Observatory, Cape Town 7925, South Africa.Groote Schuur Hospital, Orthopaedic Surgery, Old Main BuildingMain Rd, ObservatoryCape Town 7925South Africa

Upper extremity gunshot fractures are generally treated conservatively or surgically using open reduction and internal fixation (ORIF), intramedullary nails (IM) or external fixators. However, there is no gold standard for the management of these complex, multi-fragmentary upper extremity fractures. The aim was to describe and identify the injury patterns, management, complications and associated risk factors for upper extremity gunshot fractures.

Patient and methods

Data of patients with upper extremity gunshot injuries that presented to a Level I Trauma Unit in Cape Town, South Africa was collected prospectively over a ten-month period from June 2014 to April 2015. Clinical notes and radiographs were reviewed retrospectively.


Fifty-one of 90 patients (56.7%) with ballistic injuries had fractures, 30% had neurovascular injuries and 75% had additional injuries to other anatomical structures including head, neck, spine, chest, abdomen, pelvis and urogenital tract. Most fractures were diaphyseal, multi-fragmentary and extra-articular. Fractures were treated conservatively in more than half of the cases. Median fracture length was 5.5 centimetres. A longer fracture zone was statistically associated with surgical treatment. When surgically treated, open reduction and internal fixation was most often performed. Median hospital stay was six days. Infection and injury severity prolonged hospital stay.


In contrast to studies from the USA and Europe, most fractures in this study were managed conservatively. High quality prospective controlled trials are required to evaluate radiographic and clinical outcomes of treatment methods for upper extremity gunshot injuries.

Level of evidence

IV, case series.

The full text of this article is available in PDF format.

Keywords : Orthopaedic trauma, Gunshot, Epidemiology, Upper extremity, Humerus, Radius

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