Variation in treatment of long bone gunshot wound fractures across South Africa.

Abstract

The incidence of civilian gunshot injuries is on the rise worldwide. Unfortunately, there is a lack of high-level evidence guiding management. The treatment of orthopaedic injuries from gunshots is complex and requires consideration of multiple aspects, including energy transfer to the tissue, severity of the wound, possible contamination, presence of fractures and associated injuries. Our study aimed to describe the variations in the treatment of GSW fractures across orthopaedic units across South Africa, a country with a high burden of GSW injuries. The gunshot-related injuries in trauma (GRIT) study was a snapshot study by a multicentre research network in South Africa. During the study period, a survey was distributed to the participating units. The aim was to determine variations in practice in certain key aspects of the management of GSW fractures across South Africa. Twenty-three units representing all nine provinces in South Africa responded to the survey. All responding units managed gunshot injuries. The results showed great variation in the management in the bullet tract. While all units administered prophylactic antibiotics, there was no consensus on the duration. In a simulated case of a lower limb long bone fracture caused by a low-velocity gunshot, most units (n-18) indicated that they would manage the fracture with an intramedullary nail. In South Africa, a country with a high burden of GSW injuries, there is substantial variability in the management of GSW fractures, especially of the long bones of the lower limb. Across participating units, there were variations in the treatment of the GSW tract, duration of prophylactic antibiotics and choice of fixation.