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Shots fired: evaluation of vascular injury, compartment syndrome, and transfusion rates among civilian ballistic orthopaedic fracture patients presenting to two Level I trauma centres

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

This study investigates baseline patient demographics and predictors of vascular injury, blood transfusion, and compartment syndrome in patients with orthopaedic fractures secondary to GSWs at two high-volume Level I trauma centres.

Methods

A retrospective chart review of all GSW-related trauma patients at two Level I trauma centres between July 2019 and September 2021 was conducted. Chi-squared and two-tailed independent t tests were used for data analysis, and logistic regression with odds ratios (OR) determined predictors of primary outcomes.

Results

Among 478 GSW patients, 94 (19.7%) sustained 130 orthopaedic fractures, most commonly at the lower extremity (77.7%). Orthopaedic fracture patients showed significantly higher rates of vascular injury (29.8 vs. 4.7%, p < 0.001), transfusion (27.7 vs. 12.8%, p = 0.006), and compartment syndrome (3.2 vs. 0.3%, p = 0.011) compared to non-orthopaedic injury patients. Univariable analysis identified ankle (OR = 47.50, p < 0.001) and hip/femur fractures (OR = 5.31, p < 0.001) as predictors of vascular injury. Multivariable logistic regression revealed lower extremity vascular injury (OR = 54.69, p = 0.006) and anatomic fracture sites of the humerus (OR = 15.17, p = 0.008), clavicle/scapula (OR = 11.30, p = 0.009), and acetabulum/pelvis (OR = 7.17, p = 0.025) as predictors of blood transfusion. Univariable analysis showed lower extremity vascular injury (OR = 30.14, p = 0.007) as a predictor of compartment syndrome.

Conclusion

These findings underscore the importance of diagnosing and managing vascular injuries and compartment syndrome in GSW-related orthopaedic fractures, emphasizing the necessity for targeted transfusion strategies in such cases.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY, USA

    Eric H. Tischler, Patrick P. Nian, Paul Mastrokostas, Adam J. Wolfert & Ishaq Ibrahim

  2. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Bone and Joint Research Center and Chang Gung University, F7, No 222 Mai-King Road, Keelung, Taiwan

    Sung Huang Laurent Tsai

  3. Department of Orthopaedic Surgery, Northwell Health-Staten Island University Hospital, New York City, NY, USA

    Jonathan M. Gross

  4. Department of Orthopaedic Surgery, Lincoln Hospital, Bronx, NY, USA

    Aden N. Malik & Nishant Suneja

  5. Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Nishant Suneja

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  1. Eric H. Tischler
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Tischler, E.H., Nian, P.P., Mastrokostas, P. et al. Shots fired: evaluation of vascular injury, compartment syndrome, and transfusion rates among civilian ballistic orthopaedic fracture patients presenting to two Level I trauma centres. Eur J Orthop Surg Traumatol (2024). https://doi.org/10.1007/s00590-024-03955-1

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