Gunshot wounds to the hand : Management and economic impact. Discussion.
Northeastern Society of Plastic Surgeons. Newport, RI, USA, 1998/10/23.
Low-velocity firearms represent the majority of civilian gunshot wounds to the hand, yet much of the literature is based on high-velocity injuries.
The authors reviewed their treatment regimen for civilian gunshot wounds to the hand and offer a treatment algorithm that emphasizes early debridement and fracture stabilization.
They also address the economic impact on society.
The authors reviewed 121 fractures in 90 patients with gunshot wounds to the hand treated at an urban trauma center during the last 5 years.
All patients were managed with irrigation and debridement, elevation, intravenous antibiotics, and early fracture stabilization.
Sixty fractures were managed with rigid internal or external fixation : Kirshner wires (26%), miniplates (16%), and external fixation (8%). Fifty-six fractures were managed with closed reduction.
Five fractures required amputation.
There was one subsequent infection and two late amputations.
The cost of hospitalization and operative care was more than $1.7 million.
For gunshot wounds to the hand the authors advocate immediate irrigation and debridement, intravenous antibiotics, early fracture stabilization, and a low threshold for internal fixation.
This regimen is supported by their low infection and complication rates.
Mots-clés Pascal : Plaie pénétrante, Main, Arme à feu, Impact économique, Coût, Hospitalisation, Débridement, Réduction chirurgicale, Fracture, Infection, Complication, Traitement, Economie, Homme, Traumatisme, Système ostéoarticulaire pathologie, Membre supérieur, Main pathologie, Chirurgie
Mots-clés Pascal anglais : Penetrating injury, Hand, Fire arm, Economic impact, Costs, Hospitalization, Debridment, Open reduction, Fracture, Infection, Complication, Treatment, Economy, Human, Trauma, Diseases of the osteoarticular system, Upper limb, Disease of the hand, Surgery
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Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0236195
Code Inist : 002B30A04B. Création : 16/11/1999.