Civilian gunshot wounds of the hip and pelvis.

Objective: To evaluate orthopaedic injuries associated with civilian hip and pelvic gunshot wounds and their required surgical interventions.

Design: Retrospective chart review.

Setting: Level I urban trauma center.

Patients: From 1999 to 2008, there were 2808 cases of gunshot wounds that reported to our hospital. Twelve hundred thirty-five patients had an associated fracture that included 42 patients with fractures of the hip and pelvis. The average age of patients was 30.3 years (range, 19-54 years) and 40 of the 42 were male. Eighteen patients (43%) underwent emergency laparotomy for suspected visceral and vascular injuries of which seven patients had a negative laporotomy. There were 18 ilium fractures, 10 hip fractures, nine acetabular fractures, seven pubic rami fractures, six sacral fractures, three sacroiliac joint injuries, and two ischial tuberosity fractures.

Intervention: Seven patients required orthopaedic surgical intervention, undergoing a total of 10 operative procedures.

Results: All fractures healed and there was no incidence of pelvic ring instability requiring surgical stabilization or chronic osteomyelitis. Nonorthopaedic injuries included 15 small/large bowel perforations (36%), seven vessel lacerations (17%), and two urogenital injuries (5%) that required surgery. Associated injuries included four patients with nerve damage that recovered partially.

Conclusions: Pelvic fractures from civilian gunshot wounds often require emergent surgery for vascular, visceral, and urogenital injuries. Orthopaedic intervention is indicated for intra-articular pathology such as removal of projectiles or bone fragments and reconstruction of the hip and rarely the acetabulum. Pelvic instability and complications of orthopaedic injuries are uncommon. These injuries require a multidisciplinary approach in their management.