Elizabeth Anne Oulette, M.D.

Orthopaedic surgeons, especially those in urban areas, face an unprecedented challenge in treating victims of firearm violence. The incidence of gunshot violence in urban areas of the United States increases each year, with ever more "exotic" weapons being added to the arsenal. Wounds from medium-velocity and low-velocity handguns are still most common, but injuries from shotguns and homemade hollow-tip bullets are being seen with more frequency at trauma centers.

Bullet wounds to the upper extremity are complex injuries, which often involve multiple structures. It is not uncommon for victims of gunshot wounds to suffer nerve, arterial, muscle, and bone damage. Extent of injury may not be apparent on initial examination, so thorough neurological and vascular evaluation is essential.

In this segment, Dr. Elizabeth Anne Oulette outlines a treatment protocol for gunshot victims developed by orthopaedists at the Ryder Trauma Center of the University of Miami, Jackson Memorial Hospital. The protocol takes into account expected lack of follow-up in many inner city patients and includes aggressive use of prophylactic antibiotics, extensive debridement and exploration, the use of internal fixation for fracture stabilization, and the institution of early motion postoperatively. After vital structures have been explored to ascertain the extent of damage, priority is given to restoring circulation. Bone grafting, necessitated by segmental bone loss, is performed five to six days after the initial debridement.

References
1. Billings JB, Zimmerman MC, Aurori B, Parsons JR, Swan KG Gunshot wounds to the extremities: experience of a Level I trauma center Orthop Rev 1991;20:519-24
2. Fackler ML, Burkhalter WE Hand and forearm injuries from penetrating projectiles J Hand Surg 1992;17-A:971-5
3. Sykes LN, Champion HR, Fouty WJ Dum-dums, hollow-points and devastators: techniques designed to increase wounding potential of bullets J Trauma 1988;28:618-23

• Total Run Time: 16:02 minutes
• Catalog Number: 2020
• Publication Date: October 1995

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