title: Functional Outcomes After Gunshot Wounds to the Foot and Ankle.
abstract: The peer-reviewed, clinical data focusing on foot and ankle gunshot wounds are limited. The present study aimed to evaluate functional outcomes in a case series according to the area of injury, articular involvement, and the presence of infection. From January 2003 through February 2011 (8 years), 37 patients treated at Sinai-Grace Hospital (Detroit, MI) for civilian gunshot wounds localized to the foot and/or ankle were reviewed. Of these, 27 (72.97%) met the inclusion criteria. All acute wounds were thoroughly irrigated in the emergency room (8 of 27, 29.63%) or operating room (19 of 27, 70.37%) within 1 hour of presentation. The injuries were categorized as either zone 1 or 2, if localized distally or proximally to the midtarsal joint, respectively. The Maryland Foot Score was recorded and compared based on the location, articular involvement, and infection status, using analysis of variance. The mean Maryland Foot Score in patients with zone 1 injuries was 89.3 (range 72 to 100) and in patients with zone 2 injures was 61.8 (range 13 to 97; p = .001). The mean Maryland Foot Score in patients with type A injuries was 93.1 (range 72 to 100) and in patients with type B injures was 69.2 (range 13 to 99; p = .001), regardless of location. Intraoperative cultures yielded Staphylococcus epidermidis (7 of 27, 25.93%) and Enterococcus cloacae (1 of 27, 3.7%). No cases of Pseudomonas aeruginosa were found, although 9 cases (33.33%) involved shoe penetration. One third of the cases (9 of 27) yielded intra-articular pain, of which 4 (14.82%) required joint arthrodesis.
authors.affiliation: Attending Physician, Department of Orthopedics, Podiatry Section, Detroit Medical Center, Detroit, MI. Electronic address: zee@alum.mit.edu.
authors.forename: Zeeshan S
authors.initials: ZS
authors.lastname: Husain
authors.affiliation: Resident, Podiatric Medicine and Surgery Residency, Detroit Medical Center, Detroit, MI.
authors.forename: Stephen
authors.initials: S
authors.lastname: Schmid
authors.affiliation: Resident, Podiatric Medicine and Surgery Residency, Detroit Medical Center, Detroit, MI.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lombardo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000628:therapy*; D005260:Female; D018409:Foot Injuries / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000628:therapy*; D055815:Young Adult
keywords: Maryland Foot Score; gunshot wound; infection; midtarsal joint; open fracture; trauma