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Early outcomes of surgically managed civilian gunshot femur fractures at a level one trauma unit in Cape Town, South Africa: a retrospective review

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Abstract

Purpose

To assess the outcome of surgically fixated femur shaft and distal femur fractures following low-velocity civilian gunshot injuries over a 4-year period.

Methods

A retrospective review was conducted on all patients who sustained femur shaft and distal femur fractures from civilian low-velocity gunshot injuries that required definitive surgical fixation between January 2014 and December 2017. Patient demographics, comorbidities, injury characteristics, duration between injury and surgical fixation and presence of complications were captured.

Results

A total of 122 patients (mean age, 29.1 ± 9.5 years) were included. Supracondylar femur fractures (AO 33) accounted for 49% of total injuries, followed by femoral shaft (AO 32) and intra-articular distal femur fractures (AO 33 B & C) with 40% and 11%, respectively. Intramedullary nail fixation was the choice of treatment for femur shaft fractures (49.98%) and supracondylar fractures (63%). Intra-articular injuries were predominantly treated with distal femoral locking plates (85%). Arterial and nerve injuries were the most commonly encountered associated injuries occurring in five patients (4.1%) each. Fracture-related infection was diagnosed in two patients (1.6%). No cases of non-union and compartment syndrome were recorded.

Conclusion

Femur shaft and supracondylar fractures fixated with intramedullary nails are associated with low complication rates and perfect union rates. Our study suggests that intra-articular distal femur fractures fixated with locking plates and cannulated screws have a high complication rate and poorer surgical outcomes. Non-union and compartment syndrome are rare complications of gunshot femur fractures fixated with either intramedullary nails or locking plates.

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Availability of data and materials

Due to the protection of personal information act of the country of origin, raw data cannot be made available without formal ethics approval. Any requests for future collaboration should be submitted to the authors.

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Acknowledgements

The authors would like to thank two anonymous reviewers for their comments and suggestions in order to improve this manuscript.

Funding

No funding has been received for this manuscript.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, 7505, South Africa

    Obakeng Makhubalo, Marilize Burger, Shafique Jakoet, Marcus Van Heukelum, Nicholas le Roux, Muaad Gerafa, Simone Van der Merwe & Nando Ferreira

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Contributions

The authors confirm that all authors have made substantial contributions to all of the following: The conception and design of the study, or acquisition of data, or analysis and interpretation of data. Drafting the article or revising it critically for important intellectual content. Final approval of the version to be submitted. Sound scientific research practice. The authors further confirm that: The manuscript, including related data, figures and tables has not been previously published and is not under consideration elsewhere. No data have been fabricated or manipulated (including images) to support your conclusions. This submission does not represent a part of single study that has been split up into several parts to increase the quantity of submissions and submitted to various journals or to one journal over time (e.g. “salami-publishing”). OM contributed to study conceptualisation, data capture, data analysis, first draft preparation, manuscript revision and approval of final manuscript. MB contributed to data analysis, first draft preparation, manuscript revision and approval of final manuscript. SJ contributed to data capture and approval of final manuscript. MvH contributed to data capture and approval of final manuscript. NlR contributed to data capture and approval of final manuscript. MG contributed to data capture and approval of final manuscript. SvdM contributed to data capture and approval of final manuscript. NF contributed to study conceptualisation, data analysis, first draft preparation, manuscript revision and approval of final manuscript.

Corresponding author

Correspondence to Nando Ferreira.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The authors declare that this submission is in accordance with the principles laid down by the Responsible Research Publication Position Statements as developed at the 2nd World Conference on Research Integrity in Singapore, 2010. Ethical approval for this study was obtained from the Stellenbosch University Ethics Committee, N18/10/125 prior to the commencement of data collection. All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Consent to participate

As this is a retrospective study reviewing patient records, a waiver of consent was requested and granted by the Stellenbosch University Ethics Committee.

Consent to publish

I, Dr Obakeng Patial Makhubalo, give my consent for the publication of this manuscript, in its entirety, in the International Orthopaedics journal.

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Makhubalo, O., Burger, M., Jakoet, S. et al. Early outcomes of surgically managed civilian gunshot femur fractures at a level one trauma unit in Cape Town, South Africa: a retrospective review. Eur J Trauma Emerg Surg 49, 859–865 (2023). https://doi.org/10.1007/s00068-022-02138-z

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