title: The role of débridement in low-velocity civilian gunshot injuries resulting in pelvis fractures: a retrospective review of acute infection and inpatient mortality.
abstract: OBJECTIVE
  To determine the use of surgical débridement in the management of low-velocity gunshot injuries (GSIs) resulting in pelvis fractures.
  
  
  METHODS
  : Retrospective chart review.
  
  
  METHODS
  Level I trauma center in a major metropolitan area.
  
  
  METHODS
  Fifty-six patients from 1991 to 2007 treated for pelvis GSIs with resulting pelvis fractures with six acute mortalities and 40 patients with at least 1-year follow-up.
  
  
  METHODS
  Patient data were reviewed for incidence of infection related to pelvis GSIs. Information regarding surgical débridement of pelvis GSI wounds, retained foreign bodies, and/or concomitant gastrointestinal (GI) injury was analyzed for relationships of such events to infection rate.
  
  
  METHODS
  Incidence of infection related to pelvis GSIs at least 1 year after GSI date.
  
  
  RESULTS
  Three patients (6%) developed a deep infection related to their pelvis GSIs. There were no cases of osteomyelitis. The rate of concomitant GI injuries was 36% and the overall infection rate among those with GI injuries was 12% versus 3% for those without a GI injury (P = 0.34). There were infection rates of 7% and 6% among patients who underwent surgical débridement and those who did not, respectively. Of those with GI injuries, 41% underwent primary surgical débridement and none developed infection. In the group of remaining patients with GI injuries who did not undergo débridement of their GSI wounds, two (20%) developed an infection. The mortality rate of low-energy GSIs to the pelvis was six of 53 (11%).
  
  
  CONCLUSIONS
  There was no increased incidence of infection in the absence of aggressive surgical débridement of pelvis GSI wounds. The study also demonstrated that retained bullets and bullet fragments did not increase the risk of infection, even after penetrating the GI tract organs. Finally, this study suggests there may be an increased risk of infection related to pelvis GSIs compared with reported infection rates related to GSIs of the extremities, likely secondary to a high rate of concomitant GI injuries associated with pelvis GSIs; however, there was no incidence of osteomyelitis.
authors.affiliation: Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. bmullis@iupui.edu
authors.forename: Jason
authors.initials: J
authors.lastname: Watters
authors.forename: Jeffrey O
authors.initials: JO
authors.lastname: Anglen
authors.forename: Brian H
authors.initials: BH
authors.lastname: Mullis
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement / Q000379:methods*; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D041981:Gastrointestinal Tract / Q000293:injuries / Q000601:surgery; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000601:surgery; D010019:Osteomyelitis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D014193:Trauma Centers; D014948:Wounds, Gunshot / Q000150:complications / Q000401:mortality / Q000601:surgery*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents