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Abstract
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OBJECTIVE: To describe humerus shaft fractures after low energy GSW and compare with blunt injuries. We hypothesized that nerve injury, infection, and fracture union would be similar.
DESIGN: Retrospective. SETTING: Urban level 1 trauma centerPatients/Participants: 403 patients were treated for a humeral shaft fracture over 18 years. Sixty-two patients sustained injury due to GSW. INTERVENTION: Primary ORIF was pursued in 59%, including 32% following GSW. MAIN OUTCOME MEASUREMENTS: Rates of nerve injury, infection, and fracture union.
RESULTS: GSW patients were younger with a mean age of 30 years, more likely male (90%), with isolated injuries (84%), and less likely to have simple fractures (84%). Both groups experienced high rates of union (98% of GSW fractures versus 99% of closed high-energy fractures). Deep infection occurred in one patient (1.6%) after GSW. Rates of deep infection in the closed and open blunt trauma fracture groups were similarly low at 1% and 4.5%, respectively. Nerve injury on presentation after GSW was more common than after low and high-energy closed fractures (47% versus 13% and 27%), but similar to blunt open fracture (52%). Despite higher rates of nerve injury, nerve recovery occurred at similarly high rates following both GSW and blunt injuries (78% versus 86%).
CONCLUSIONS: Nerve injuries are more common after GSW, but most recover without intervention. Infection is uncommon after GSW, and secondary unplanned operations are rare. Initial nonoperative care of most GSW humerus fractures, even with radial nerve injury at time of presentation, appears appropriate. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Language: en |