Multicenter Comparison of Outcomes for Management of GSW Humerus Fractures
Location
LSUHSC-NO Center for Advanced Learning and Simulation
Document Type
Presentation
Start Date
21-6-2025 8:45 AM
End Date
21-6-2025 9:05 AM
Publication Date
June 2025
Description
Introduction: Gunshot wounds (GSWs) are a major cause of injury and disability in the US. Although humerus fractures unrelated to ballistic injury have been successfully managed both operatively and nonoperatively, the outcomes of GSW-induced humerus fractures remain more uncertain. We aim to compare outcomes, both radiographic and clinical, between operative and nonoperatively treated GSW-induced humerus fractures.
Methods: We conducted a retrospective chart review of patients aged 18 or older who sustained a GSW-induced humerus fracture and presented at one of 9 university hospitals between January 2016 and October 2021. Data, including demographic and clinical details, GSW-related information, and outcomes, were extracted from medical charts. Patients were categorized based on surgical intervention (operative vs nonoperative), and the univariate association with various outcomes was analyzed using either a χ2 test or a t-test.
Results: A total of 427 patients were included in the preliminary analysis (291 operative vs 146 nonoperative). No significant differences were observed between the 2 groups in age (P = 0.644), gender (P = 0.174), race (P = 0.310), or insurance (P = 0.403). The majority of patients were male (88.1%), African American (78.9%), and had Medicaid insurance (61.4%). Median age was 28 years old (range, 18-75). Operative patients had a higher prevalence of nerve (46.7% vs 22.1%, P<0.001) and vascular injury (17.5% vs 4.4%, P<0.001). 61.2% of operative patients and 42.7% of nonoperative patients had at least 1 follow-up 60 days or later after hospital discharge. Overall, operative treatment was associated with a higher infection rate (6.5% vs 0.7%, P = 0.006) and observed nonunion rate (10.7% vs 4.4%, P = 0.033), while observed union rates did not significantly differ (49.1% vs 44.4%, P = 0.093).
Conclusion: Patients who underwent operative treatment were more likely to have preoperative nerve and vascular injury. Operative treatment of GSW-induced humerus fractures was associated with higher rates of infection and nonunion.
Recommended Citation
Haydel, Adam MD, "Multicenter Comparison of Outcomes for Management of GSW Humerus Fractures" (2025). Dept. of Orthopaedics: Robert D. D’Ambrosia Lectureship & Research Day. 1.
https://digitalscholar.lsuhsc.edu/ortho_rd/2025/presentation1/1
Multicenter Comparison of Outcomes for Management of GSW Humerus Fractures
LSUHSC-NO Center for Advanced Learning and Simulation
Introduction: Gunshot wounds (GSWs) are a major cause of injury and disability in the US. Although humerus fractures unrelated to ballistic injury have been successfully managed both operatively and nonoperatively, the outcomes of GSW-induced humerus fractures remain more uncertain. We aim to compare outcomes, both radiographic and clinical, between operative and nonoperatively treated GSW-induced humerus fractures.
Methods: We conducted a retrospective chart review of patients aged 18 or older who sustained a GSW-induced humerus fracture and presented at one of 9 university hospitals between January 2016 and October 2021. Data, including demographic and clinical details, GSW-related information, and outcomes, were extracted from medical charts. Patients were categorized based on surgical intervention (operative vs nonoperative), and the univariate association with various outcomes was analyzed using either a χ2 test or a t-test.
Results: A total of 427 patients were included in the preliminary analysis (291 operative vs 146 nonoperative). No significant differences were observed between the 2 groups in age (P = 0.644), gender (P = 0.174), race (P = 0.310), or insurance (P = 0.403). The majority of patients were male (88.1%), African American (78.9%), and had Medicaid insurance (61.4%). Median age was 28 years old (range, 18-75). Operative patients had a higher prevalence of nerve (46.7% vs 22.1%, P<0.001) and vascular injury (17.5% vs 4.4%, P<0.001). 61.2% of operative patients and 42.7% of nonoperative patients had at least 1 follow-up 60 days or later after hospital discharge. Overall, operative treatment was associated with a higher infection rate (6.5% vs 0.7%, P = 0.006) and observed nonunion rate (10.7% vs 4.4%, P = 0.033), while observed union rates did not significantly differ (49.1% vs 44.4%, P = 0.093).
Conclusion: Patients who underwent operative treatment were more likely to have preoperative nerve and vascular injury. Operative treatment of GSW-induced humerus fractures was associated with higher rates of infection and nonunion.
Comments
Chief Resident Presentation