Along with military injuries, gunshot wounds are becoming increasingly common in a civilian’s life and it becomes necessary to understand the various areas that can be affected due to gunshot wounds. While gunshot wounds can affect almost any region of the body, certain areas where vital organs are located can be prove to be more challenging.
The impact created by the penetrating bullet depends much on the nature of the bullet, the position of the victim when hit, the region and the type of tissues affected. As regards gunshot wound to hip and pelvis, as the region involves both orthopedic structures as well as important internal organs, there is a risk of damage to these.
What Kind Of Hip And Pelvis Injuries Can Be Caused By Gunshot?
Gunshot wounds can cause penetrating injury to the bone and soft tissues related to the pelvic girdle. Gunshot wound to the pelvis can involve injuries to various organ systems. Penetrating injuries to the pelvic area may include injury to abdominal and pelvic organs. Pelvic fractures can be a common result, which may be complicated with injuries to internal structures like intra-abdominal organs, urogenital organs and important blood vessels. Fractures noticed include various areas and joints of the hip and pelvis like ilium, hip, acetabulum, pubic rami, sacral region, sacroiliac joint and ischial tuberosity fractures.
Additional injuries to the internal pelvic structures can cause damage to small bowel perforations, lacerations of blood vessels, urogential injuries and even damage to the nerves. As these injuries occur in different areas belonging to various medical specialties, a multi disciplinary approach at the trauma center is required in wound management and further treatment.
Management Of Hip And Pelvic Injuries Caused By Gunshot
A detailed history of the gunshot firing can help in assessing the type of injuries and planning the management. The direction of the bullet and the projectile path needs to be determined. The entry and exit wounds, if any need to be studied carefully. Factors like the exact area which was hit by the bullet, the victim’s position, immediate reaction or movement and number of bullets shot should be evaluated. The path that can be imagined between the entry and exit wound can give an idea of possible injuries to the organs and structures located on the way.
Assessment – As an initial assessment, the condition of the patient is noted. In case of pelvic fractures, the stability of fracture and hemodynamic state of the patient is evaluated. All possible sites are examined to check for bleeding and abdomen, chest and urogential organs are evaluated.
The pelvic and the perineal regions are carefully examined for injuries. In case of open pelvic fractures, the chances of open injuries to these areas are high, which need early detection and immediate treatment to control bleeding and reduce the mortality rate.
Investigations – The necessary investigations are performed including X-rays to detect bone involvement and fractures. Further CT scan can help to determine possible intraarticular missile and detailed evaluation of bone injury with 3D reconstruction. Bullet tract can be determined by using contrast CT scan with studies like cystogram, sonogram, retrograde urethrogram and intravenous pyelogram. Further, investigations to detect injuries to specific pelvic organs and structures may be performed.
Treatment Of Gunshot Wound To Hip And Pelvis
For orthopedic injuries, appropriate wound care is decided based on the missile velocity and nature and extent of injury. Pelvic fractures can cause bleeding and need immediate attention. Wound treatment is followed by fracture stabilization and antibiotic therapy for infection prophylaxis is considered. Pelvic stabilization performed in time can prevent excessive blood loss and reduce the mortality rate. The degrees of displacement determine the extent of injury; additional disruption of sacroiliac or other associated ligaments should also be considered.
The key areas are to control bleeding, which is obtained by performing methods that reduce volume of pelvic and stabilize the pelvis. Mechanical stabilization may be performed using binders, sheets or fixation methods. Iliac vessels may be injured and need appropriate management. Intraarticular missiles need to be identified and treated as they can lead to inflammation and lead intoxication or plumbism. Arthrotomy procedure may be performed in certain cases.
Special consideration is given to treatment of intraarticular bullets and bullets retained in spinal canal. In injuries to spinal canal, retained bullet fragments or presence of neurologic deficits may be considered for surgical intervention. Injuries to femoral nerve may be treated with medications and surgical exploration for associated injuries may be considered.
Regional Injuries – Wound management of the specific region is considered for injury to abdominal organs. Laparotomy may be performed if found appropriate. During this procedure, the entire tract that the bullet has traversed is debrided. The abdominal cavity is cleaned and any injury to internal organs is identified and repaired. Recent studies also aim at evaluating the non-operative management for pelvic gunshot wounds causing abdominal injuries, as an alternative to laparatomy procedure and may be followed safely and effectively in certain appropriate cases.
Other procedures for rectal injuries may also be performed in some cases. Bullet lodged inside the body needs to be removed. Antibiotic therapy is given to prevent the risk of infections.
- OrthoInfo – Pelvic Fractures: https://orthoinfo.aaos.org/en/diseases–conditions/pelvic-fractures/
- Current Reviews in Musculoskeletal Medicine – Gunshot Wounds to the Musculoskeletal System: https://link.springer.com/article/10.1007/s12178-019-09593-x
- The Journal of Bone & Joint Surgery – Gunshot Wounds in Orthopaedics: Classification, Treatment, and Prognosis: https://journals.lww.com/jbjsjournal/Abstract/2017/07200/Gunshot_Wounds_in_Orthopaedics__Classification,.11.aspx
- Injury – Gunshot wounds to the extremities: Evaluation, diagnosis, and management: https://www.sciencedirect.com/science/article/pii/S0020138318303490
- Trauma.org – Gunshot Wound Injuries: https://www.trauma.org/archive/injury/gsw.html