title: Infection and Complications After Low-velocity Intra-articular Gunshot Injuries.
abstract: OBJECTIVE
  The purpose of this study is to characterize the demographics, interventions, infection rates, and other complications after intra-articular (IA) gunshot wounds.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  Fifty-three patients with 55 civilian low-velocity IA gunshot injuries with a minimum of 4 weeks follow-up were included in the study. Seven patients had associated vascular injuries.
  
  
  METHODS
  Most patients (84.9%) received antibiotic prophylaxis, consisting most often of cefazolin (93.3%). Based on injury pattern and surgeon preference, joint injuries were either treated nonoperatively (43.6%), with surgical debridement only (20.0%), with surgical debridement plus fracture fixation and/or neurovascular repair (32.7%), or with percutaneous fracture fixation without debridement (3.6%).
  
  
  METHODS
  Incidence of deep infection.
  
  
  RESULTS
  Two joints (3.6%) developed deep infections. Both had associated vascular injuries. Patients with vascular injuries were at higher risk of infection compared with those without vascular injury (28.6% vs. 0.0%, P = 0.02). Two of 24 (8.3%) injuries that were originally managed nonoperatively required delayed surgical procedures, 1 for bullet removal and 1 for ulnar nerve allograft. No patient treated nonoperatively developed an infection.
  
  
  CONCLUSIONS
  The incidence of infection after IA gunshot injuries is low with the routine use of antibiotic prophylaxis. In the absence of IA pathology, IA gunshot injuries do not appear to necessitate surgical debridement to decrease the risk of infection. Patients with vascular injury deserve special attention, as they are at higher risk of infection.
  
  
  METHODS
  Prognostic Level III. See Instructions for authors for a complete description of levels of evidence.
authors.affiliation: MetroHealth System, Case Western Reserve University, Cleveland, OH.
authors.forename: Mai P
authors.initials: MP
authors.lastname: Nguyen
authors.forename: Michael S
authors.initials: MS
authors.lastname: Reich
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: OʼDonnell
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Savakus
authors.forename: Nicholas F
authors.initials: NF
authors.lastname: Prayson
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Golob
authors.forename: Amy A
authors.initials: AA
authors.lastname: McDonald
authors.forename: John J
authors.initials: JJ
authors.lastname: Como
authors.forename: Heather A
authors.initials: HA
authors.lastname: Vallier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D001134:Arm Injuries / Q000453:epidemiology / Q000628:therapy; D015984:Causality; D002648:Child; D015897:Comorbidity; D003646:Debridement / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D057072:Intra-Articular Fractures / Q000453:epidemiology* / Q000601:surgery*; D007869:Leg Injuries / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome; D014946:Wound Infection / Q000453:epidemiology* / Q000628:therapy*; D014948:Wounds, Gunshot / Q000453:epidemiology* / Q000628:therapy*; D055815:Young Adult