title: Grading system for gunshot injuries to the femoral diaphysis in civilians.
abstract: One hundred patients had surgical treatment for a gunshot injury to the femur at the authors' hospital. Each injury was classified (Grade 1-3) based on clinical and radiographic signs of deep soft tissue necrosis. All patients were followed up for a minimum of 6 months (average, 18 months; range, 6 months-72 months). Grade 1 injuries are defined by small entry and exit wounds (< 2 cm) and the absence of high-energy characteristics on plain radiographs. Grade 2 gunshot injuries have small wounds (< 5 cm) and radiographic evidence of a high-energy injury. Grade 3 gunshot injuries are diagnosed by physical examination whenever necrotic muscle is present at the fracture site. Radiographs show extensive superficial and deep soft tissue disruption and segmental bone destruction. Seventy-nine patients with Grade 1 fractures had intramedullary nailing without wound exploration; all fractures united without infection. Seven patients with Grade 2 injuries had wound exploration; a necrotic cavity was discovered in five patients and three (43%) patients had deep infection develop. Fourteen patients with Grade 3 injuries had one or more debridements followed by skeletal stabilization, and seven patients (50%) had deep infection develop. Important decisions regarding wound debridement and fracture stabilization are determined by examination of the wound and radiographs, and not by determining muzzle velocity.
authors.affiliation: Dr. Martin Luther King/Charles Drew Medical Center, Los Angeles, CA 90059, USA. sputilong@aol.com
authors.forename: William T
authors.initials: WT
authors.lastname: Long
authors.forename: Wayne
authors.initials: W
authors.lastname: Chang
authors.forename: Earl W
authors.initials: EW
authors.lastname: Brien
mesh_terms: D000293:Adolescent; D000328:Adult; D003646:Debridement; D005260:Female; D005264:Femoral Fractures / Q000145:classification* / Q000473:pathology / Q000601:surgery; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology; D009336:Necrosis; D014948:Wounds, Gunshot / Q000145:classification* / Q000473:pathology / Q000601:surgery