K. C. Banks1, C. M. Mooney1, N. J. Alcasid1, C. J. Susai1, K. Mazzolini1, T. D. Browder1, G. P. Victorino1 1University of California, San Francisco- East Bay, Oakland, CA, USA
Introduction:
Concurrent colonic injury among patients with gunshot-related fractures presents a potential risk for infectious complications. Given the potential seeding of contaminant related to the missile trajectory or even possible transient hematogenous spread of bacteria to distant sites, it is possible that such injuries may have increased risk of infectious complications. We hypothesized that colon injuries increase the risk of infectious orthopedic complications among gunshot victims with concurrent fractures.
Methods:
We retrospectively reviewed all trauma patients arriving at our university-based level 1 trauma center from January 1, 2019 to May 31, 2022 who suffered gunshot related fractures and also underwent an exploratory laparotomy. All fracture types were included, and patients were divided into groups based on whether there was a concurrent colon injury or not. Variables of age, sex, race/ethnicity, injury severity score (ISS), and antibiotic regimens were collected in addition to outcomes of length of stay (LOS), ICU admission, ventilator requirement, and development of infectious orthopedic complications. Such infectious complications included septic arthritis, orthopedic deep surgical site infections, and osteomyelitis. Chi-Squared and Mann-Whitney U tests were performed for categorical and nonnormal continuous data, respectively.
Results:
Overall, 107 patients met inclusion criteria with 56 patients with colonic injury and 51 patients without. Age, sex, race/ethnicity, and ISS were not different between the groups (Table 1). Patients in the two groups had similar rates of gram positive coverage within 48 hours, but those with colonic injuries were more likely to receive gram negative (57.1% vs 21.6%, p<0.001) and anaerobic (67.9% vs 27.5%, p<0.001) coverage within 48 hours. Only patients with colon injuries developed infectious orthopedic complications (10.7% vs 0.0%, p=0.03). All patients with such complications had pelvic or acetabular fractures. Patients with infectious orthopedic complications had similar rates of gram positive, gram negative, and anaerobic coverage within 48 hours compared to those without infectious orthopedic complications. There was no difference in LOS, ICU admission, or ventilator requirement between the two groups.
Conclusion:
Concurrent colon injuries among patients with gunshot-related fractures are associated with higher risk of infectious orthopedic complications. Based on the pelvic location, the orthopedic infections identified in our study may have been related to direct spread of contaminant. The optimal antibiotic regimen and treatment for such patients remains unclear.
