OSET 2017 David B. Weiss, MD University of VA Dept. Orthopaedic - PowerPoint PPT Presentation

OSET 2017 David B. Weiss, MD University of VA Dept. Orthopaedic Surgery

Disclosures • OTA- Education Committee • DepuySynthes- Consulting • Globus Medical- Consulting • AO North America- Teach Courses • Elsevier- Royalties • METRC- Site PI

This Dude’s been shot!!!

61 yo M Shotgun to left thigh (close range) during home invasion FBI.gov (Mannequin)

Low vs High Velocity • Low velocity (<1000 ft/sec)- typical handgun – Damage confined to missile tract- – More deformity of bullet – Less zone of injury – Can treat like closed fracture – High Velocity (<2000 ft/sec) will be blast and increased soft tissue damage- need more extensive debridement. – Shotgun at close range considered high energy – Treat as open fracture

Deformation increases with velocity Library.med.utah.edu

Cavitation from www.Quora.com

Management of GSW • ATLS principles • Follow the bullet tracks- look for entry and exit wounds • Neuropraxia often transient from shockwave or bone displacement

38 yo M accidental 9mm to thigh

38 yo M accidental 9mm to thigh

Post Op

21 yo F 40 caliber

Post Op

15 mos post op-returned to sport

High velocity injury Contrast with pistol injury To femur This has much bigger zone of injury and fragmentation Orthobullets.com

Helpful tips • Understand type of GSW if known (handgun vs rifle) – High velocity will need extensive debridement • Shotgun blast at close range treat like open fx- lots of tissue destruction (may have wadding in wound) • Powder burns on skin indicate close range (more energy) • Not necessary to debride all fragments but some may block IM canal (study images closely)

Back to the first case

Success (at least for now)