title: Outpatient management of low-velocity gunshot-induced fractures.
abstract: This prospective study evaluated the efficacy of an outpatient management protocol for patients with a gunshot-induced fracture with a stable, nonoperative configuration. Forty-one patients (44 fractures) with a grade I or II open, nonoperative fracture secondary to a low-velocity missile comprised the study population. Patients were treated by a standard protocol, which included 1 g of cefazolin administered in the emergency room and a 7-day course of oral cephalexin. Follow-up visits were performed until complete wound and fracture healing were achieved. Thirty-two (78%) of 41 patients underwent full follow-up. Average follow-up was 5.2 months. One (2.8%) fracture (distal fibula) developed a superficial infection, which responded to an additional week of oral antibiotics, and no patient developed a deep infection. There was 1 delayed union and 2 patients with painful retained shrapnel. These results demonstrate that patients with stable, low-velocity, gunshot-induced fractures can be managed effectively and safely on an outpatient basis using this protocol.
authors.affiliation: Department of Orthopedic Surgery, Tulane University School of Medicine, New Orleans, LA 70112-2699, USA.
authors.forename: K
authors.initials: K
authors.lastname: Dickson
authors.forename: T S
authors.initials: TS
authors.lastname: Watson
authors.forename: C
authors.initials: C
authors.lastname: Haddad
authors.forename: J
authors.initials: J
authors.lastname: Jenne
authors.forename: M
authors.initials: M
authors.lastname: Harris
mesh_terms: D000328:Adult; D000368:Aged; D002437:Cefazolin / Q000627:therapeutic use; D002506:Cephalexin / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D014948:Wounds, Gunshot / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D002511:Cephalosporins; D002437:Cefazolin; D002506:Cephalexin