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What It Is
• Penetrating ballistic injuries that can cause fractures or soft-tissue damage (Fig. 1)
When to Be Suspicious
• Based on both history and physical exam. Gunshot wounds are usually clinically
apparent, provided that a thorough secondary survey has been performed and all
skin exposed.
Fig. 1 Radiograph (a) and CT scan (b) of a gunshot wound involving the femoral neck
How to Diagnose
How to Treat
• Low-velocity wounds are treated as if they were closed fractures despite the skin
injuries:
° Tetanus, oral antibiotics, local wound care
• High-velocity wounds may require I+D if soft-tissue envelope is severely
damaged/compromised.
References
Bartlett CS, Helfet DL, Hausman MR, Strauss E. Ballistics and gunshot wounds: effects on mus-
culoskeletal tissues. J Am Acad Orthop Surg. 2000;8(1):21–36.
Geissler WB, Teasedall RD, Tomasin JD, Hughes JL. Management of low velocity gunshot-
induced fractures. J Orthop Trauma. 1990;4:39–41.