Treatment of secondary hip arthritis from shell fragment and gunshot injury in the Syrian civil war

• Published in: Journal of orthopaedic surgery and research Vol. 15; no. 1; p. 464
• Main Authors: Özden, Raif, Davut, Serkan, Doğramacı, Yunus, Kalacı, Aydıner, Duman, İbrahim Gökhan, Uruç, Vedat
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08-10-2020; BioMed Central; BMC
• Subjects: Adult; Armed Conflicts; Arthritis; Arthroplasty; Arthroplasty, Replacement, Hip; Cartilage diseases; Civil war; Drug therapy; Female; Fractures; Hip; Hip gunshot; Hip joint; Hip replacement arthroplasty; Humans; Infection; Infections; Joint and ligament injuries; Joint replacement surgery; Joint surgery; Male; Medical research; Metronidazole; Middle Aged; Orthopedics; Osteoarthritis; Osteoarthritis, Hip - diagnosis; Osteoarthritis, Hip - etiology; Osteoarthritis, Hip - therapy; Osteosynthesis; Patients; Prostheses; Retrospective Studies; Secondary hip osteoarthritis; Severity of Illness Index; Shell fragment injuries; Statistical analysis; Surgeons; Surgery; Surgical Wound Infection - epidemiology; Surgical Wound Infection - prevention & control; Total hip arthroplasty; Trauma; War; War-Related Injuries - complications; Wounds, Gunshot - complications; Young Adult; United States > US; Arthroplasty; Secondary hip osteoarthritis; Hip gunshot; Shell fragment injuries
• ISSN: 1749-799X; 1749-799X
• DOI: 10.1186/s13018-020-01993-z

In gunshot and shell fragment injuries to the hip joint, orthopedic intervention includes wound assessment and care, osteosynthesis of fractures, and avoiding of infection and osteoarthritis. Individuals injured in the Syrian civil war were frequently transferred to the authors' institution in neighboring city. Orthopedic trauma exposures were determined in approximately 30% of these patients. The aim of this study was to evaluate the outcomes of the patients with secondary hip arthritis due to prior gunshot and shell fragment (shrapnel) injuries who underwent primary total hip arthroplasty.
This retrospective study reviewed 26 patients (24 males, 2 females) who underwent hip arthroplasty due to prior gunshot and shell fragment injuries from November 2013 to January 2019. For all patients, the Harris Hip Score (HHS) was evaluated preoperatively and after surgery.
Mean age was 31.5 (range, 19-48) years. The mean preoperative HHS was 52.95 points, and the mean postoperative HHS was 79.92 points at the final follow-up after surgery. Patients with shell fragment injuries to the hip joint had higher infection rates, but it is not statistically significant.
An anatomic reduction of the fracture may not be possible in these cases as a result of significant bone and/or cartilage loss. Total hip arthroplasty can be done after gunshot- and shell fragment-related posttraumatic arthritis. It is an effective treatment choice to reduce pain and improve function, but the surgeon must be very careful because of high rate of infection.