Abstract

ABSTRACT :
BACKGROUND:
High velocity missile injuries (HVMIs) are increasing among civilians, the mechanism causing such injuries are totally different from blunt trauma. These injuries associated with complications such as soft tissue injury, vascular injury, infection and nonunion. in addition to systemic, economic and psychological complications.
OBJECTIVE :
A retrospective and prospective review of case series aimed to conclude the rate of non union in HVM fractures, and to explore the important factors that increase this risk (timing, severity, Infection, and non-steroidal anti-inflammatory drugs).
In this part of the study we will discuss the effect of severity, timing of wound debridment and infection.
PATIENTS AND METHOD:
A 109 limb injuries in 97 patients (victims of high velocity missiles) treated at Orthopedic department in Medical City in Baghdad/Iraq in the period 2004-2008 were studied. Data for timing of surgical management, severity, deep infection rate, nonunion, drug administration and smoking were collected from medical city records, patient questionnaire and follow up in outpatient department both clinically and radiologically for a minimum of one year.
RESULTS:
The rate of non union was 29.36%, and the rate of deep infection was 28.44%, the most important factor affecting non union is infection, nonunion associated with infection in 50% of nonunion (infection increases the risk of nonunion three times), Severity(minor, moderate and severe) is another important factor the rate of nonunion was 26.51% in moderate and 38.46% in severe injuries, infection was 25.30% in moderate and 38.46% in severe injuries.
Timing of debridment in our study showed no effect on the rate of non union or infection (nonunion rate was 28.57% and infection was 30.35% if debridment done less than 6 hours after injury and 30.19% nonunion and 26.41% infections for more than 6 hours after injury treated group).
CONCLUSION:
HVMIs causing severe types of open fractures, with high rate of non union and infection. Severity of the injury increases the risk of nonunion and infection. Infection increases nonunion risk three times, and there is no effect of timing of surgical management on the rate of nonunion or infection.