Transarticular gunshot injuries: a systematic review of 150 years of management

Abstract

Background: This review aims to collate all published work on the management of transarticular gunshot injuries to better inform decision-making when managing these injuries.

Methods: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta- Analysis (PRISMA) was undertaken. A literature search of major electronic databases was conducted to identify journal articles relating to the management of transarticular gunshot injuries published from database inception until 31 January 2021.

Results: Sixty-eight publications reporting on the management of 544 patients were included. Injuries to the lower limbs were reported in 438 cases (81%), while injuries to the upper limb accounted for 106 cases (19%). A total of 145 patients (27%) developed a deep infection. Following the routine use of antibiotics, 6% of patients (14/251) developed an infection. A  significantly higher hip joint infection rate was seen in patients who sustained associated hollow viscus injury (11/30, 37%).

Conclusion: The management of transarticular gunshot injuries is currently based on limited high-quality evidence. Modern antibiotic and surgical management practices have resulted in low overall septic complications; however, different joints have different injury and complication profiles. Future research should be aimed at identifying joint-specific evidence-based care pathways.

Level of evidence: Level 4