Management of long bone fractures and associated injuries from gunshots at a nigerian tertiary hospital.
BACKGROUND
Globally, management of gunshot injuries (GSI) encompasses resuscitation, evaluation and treatment. Wound debridement is mandatory, while definitive treatment of any associated fracture varies from one part of the world to another. In developed countries aggressive modalities of early operative fixation of such fractures have produced good results. In the Nigerian environment, the approach to such fractures is controversial and cautious, with secondary operative and even non-operative methods still being predominant.


OBJECTIVE
To compare operative versus non-operative methods of treatment of long bone fractures and associated injuries from gunshots in our centre.


METHODS
This is a prospective study of long bone fractures and associated injuries from civilian gunshots presenting at Lagos University Teaching Hospital (LUTH), Lagos, Nigeria between 1st January 2000 and 31st December 2003. LUTH, one of the tertiary hospitals in Nigeria receives most of the multi-system trauma referrals in Lagos State, Nigeria.


RESULTS
Three hundred and sixty patients with GSI were studied, 322 (89.4%) were males while 38 (10.6%) were females, giving a male: female ratio of 8.5:1. One hundred and thirty-six patients (37.8%) had long bone fractures, 94 (69.1%) on the lower limbs. All wounds were debrided and 198 (55.0%) had serial debridement. Eighty-two (60.3%) of 136 patients with fractures from G.S.I had operative treatment done secondarily and 87.5% of them achieved union. Also 42 (77.8%) of 54 patients treated non-operatively achieved union. Two hundred and thirty-four (65.0%) of the gunshot wounds healed by secondary intention, 81 (22.5%) had split thickness skin grafting and 18 (5.0%) had flap cover.


CONCLUSIONS
This study showed that secondary operative treatment of long bone fractures in GSI produces good outcome.
Obalum
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DC
Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital e-mail:Obalum1@yahoo.com.
Giwa
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Ogo
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D050723:Fractures, Bone; D006801:Humans; D009549:Nigeria; D011446:Prospective Studies; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014948:Wounds, Gunshot