Outcomes and Management for Ballistic Traumatic Arthrotomies in Children.

Abstract

To evaluate if operative irrigation and debridement (I&D) is necessary for the treatment of pediatric traumatic arthrotomies (TAs) secondary to gunshot wounds (GSWs) to prevent joint infections. Design: Retrospective cohort study. US Academic Level I Trauma Center. Pediatric patients (age 0-17) with TAs secondary to GSW between 2016-2023 with at least 1-month follow-up were included. Arthrotomies included shoulder, elbow, wrist, hand, sacroiliac, hip, knee, ankle, or foot joints. The primary outcome was rate of joint infection between those who received acute operative I&D vs. nonoperative management. A sub analysis was completed only comparing "major joints". Within the cohorts, length of antibiotic treatment was compared. 57 cases of ballistic TA (50 subjects, 82% male, mean age 14.6) were included. 31/57 joints (54.4%) underwent formal operative I&D with or without fixation, while 26 joints (45.6%) did not. In the operative I&D cohort, 85% were male with a mean age 14.8 versus 79% male with mean age of 14.3 in the nonoperative group. Mean follow-up duration was 10.8 months (range 1-56 months) for both cohorts. No joint infections were documented between either group, regardless of treatment (p=1.0). 38 TAs were major joints: 23/38 (60.5%) received I&D while 15/38 (39.5%) did not. All joints received at least one dose of intravenous antibiotics. Among the operative group, 54.8% of joints received ≤ 72 hours of intravenous antibiotics (45.2% received > 72 hours), compared with 46.2% of joints in the nonoperative group (53.8% received > 72 hours). Formal operative I&D was not found to be necessary to prevent joint infection after TA secondary to GSW. Prolonged antibiotic use did not affect rates of infection. Level III.