Surgical debridement of low velocity ballistic traumatic arthrotomy did not reduce rates of early wound infection or septic arthritis

TL;DR

Surgical debridement did not improve outcomes for low-velocity ballistic joint injuries compared to antibiotics alone.

Contribution

This study challenges the routine use of surgery for treating low-velocity ballistic joint wounds.

Findings

No significant difference in wound infection rates between surgical and non-surgical treatments.

Antibiotic therapy alone was as effective as surgical debridement for preventing septic arthritis.

Abstract

To compare the incidence of ballistic wound infection and septic arthritis after operative versus nonoperative management of low-velocity ballistic traumatic arthrotomy of a major or intermediate joint.

A retrospective cohort of consecutive adults treated within 24 h of injury at one Level 1 Trauma Center of low-velocity ballistic traumatic arthrotomy of the shoulder, elbow, wrist, hip, knee, or ankle from 2019 to 2023 was identified from an orthopedic consult registry. Treatment was classified as antibiotic therapy with or without formal surgical debridement with joint irrigation. The primary outcomes of ballistic wound infection and septic arthritis were compared by Fisher’s exact test with Šidák correction.

Five hundred seventy-eight patients with ballistic extremity injuries were screened. Seventy-seven patients met inclusion criteria. Thirty-five patients (45.5%) received operative care and 42 patients (54.5%) received nonoperative care. No significant differences were observed between treatment groups by age, sex, race/ethnicity, body mass index, area deprivation index (ADI), insurance status, medical comorbidities, the joint involved, or antibiotic regimen. No statistically significant difference in the rates of ballistic wound infection (2.4% vs. 5.7%, p = 0.830) or septic arthritis (4.8% vs. 8.5%, p = 0.995) were found between antibiotic therapy alone versus formal surgical debridement with joint irrigation.

Formal surgical debridement of ballistic traumatic arthrotomy of large and intermediate joints did not provide incremental benefit over antibiotic therapy alone.

Therapeutic level IV.

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