• OBJECTIVES
    • To classify the fracture patterns of gunshot wounds to the acetabulum; identify the associated injuries and complications; determine the predictors of poor outcome and deep infection; and propose a treatment algorithm based on the results.
  • DESIGN
    • Retrospective review of two trauma registry databases over a 13-year period.
  • SETTING
    • Multicenter study.
  • PATIENTS
    • Thirty-nine gunshot wounds to the acetabulum (38 patients).
  • INTERVENTION
    • Treatment strategy was based on infection control by treating bowel and bladder injury, presence/absence of intra-articular lead, pattern, and stability of the fracture.
  • MAIN OUTCOME MEASUREMENTS
    • Merle d'Aubign√© score, rate of failures, and complications. Multivariate logistic regression analysis to detect predictors of poor outcome and deep infection.
  • RESULTS
    • There were 32 simple (82%) and seven (18%) associated fracture patterns. Bowel injuries were the most common associated injures. There was a 54% major complication rate. Significant predictors of poor outcome were high-velocity missile, involvement of the acetabular dome, abdominal injury, nerve injury, vascular injury, and male gender. Significant factors associated with deep infection were presence of a bowel injury with primary anastomosis of the bowel and an associated fracture pattern.
  • CONCLUSIONS
    • The Letournel classification system can be applied to describe these injuries. The successful treatment of the bowel injury directly correlates to infection control. Diverting colostomy is associated with a reduction of the infection rate. Overall, gunshot wounds to the acetabulum are catastrophic injuries with a high complication rate and poor functional outcome. A multidisciplinary algorithm is proposed for treatment of these complex injuries.
  • LEVEL OF EVIDENCE
    • Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.