SA Orthopaedic Journal
On-line version ISSN 2309-8309
BACKGROUND: The objective is to assess whether intramedullary (IM) nailing of the forearm (radius and/ or ulna) after low-energy gunshot wounds, is a safe and effective form of management for these complex fractures. METHODS: A prospective consecutive case series was followed from presentation to fracture union. Cases were enrolled from three tertiary level academic hospitals and one private hospital. Twenty-one patients (between April 2006 and February 2008) who sustained low-energy gunshot wounds to the radius and/ or ulna were enrolled. All fractures were stabilised using a single IM rod. Variation in soft tissue management was dependent on surgeon preference and findings. All patients were assessed subjectively; using a DASH score, objectively; by a clinical exam (focusing on range of movement and wound healing) and radiologically; assessing for fracture union. RESULTS: Fourteen patients, all with comminuted fractures, were evaluated at 1 year post-injury. The median DASH score was 7.5 (range 3.3-84), but this was influenced by soft tissue factors. All the wounds healed without complication, and range of movement was adequately restored. Three patients had residual nerve injuries, which affected outcome. The fracture union rate was high (13/14) and complication rate was limited to one non-union and one mal-union. CONCLUSION: The use of IM nailing for low-velocity gunshot fractures of the radius/ulna is safe and effective, with predictable results.
Keywords : intramedullary nailing; low-velocity/energy; gunshot wounds; fractured radius; fractured ulna.