J Trauma
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Fractures of the femur caused by gunshots are increasingly common. There is no standard treatment of these fractures since there are no clear guidelines relating these injuries to open fracture classification. We reviewed our experience with such fractures, which included 65 patients who had an immediate reamed intramedullary nail placed as treatment. ⋯ We found that all patients healed with no infections. The overall morbidity and average hospital stay were decreased compared with studies advocating delayed intramedullary nailing and prolonged intravenous antibiotics. We recommend that patients with fractures of the femur caused by gunshots are candidates for immediate reamed intramedullary nailing providing that there is only mild to moderate soft-tissue contamination and no evidence of major devitalization.
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One hundred hemodynamically stable patients with penetrating abdominal trauma (65, stab wounds, 35, gunshot wounds) were evaluated with laparoscopy. Sixty percent of the patients had wounds in the thoracoabdominal area or the upper abdominal quadrants and 25% had injuries located in the lower abdomen and flanks. Fifteen percent had epigastric wounds. ⋯ The major role of laparoscopy in penetrating abdominal trauma is in avoiding unnecessary laparotomy in tangential SWs and GSWs. It is excellent for evaluating the diaphragm in thoracoabdominal wounds. Caution is urged in excluding hollow viscus injuries based on laparoscopy.