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Ouellette Elizabeth Anne M.D.
Techniques in Orthopaedics: October 1995
Orthopaedic Lessons from Recent Wars: Articles: PDF Only


Gunshot violence in the United States has reached epidemic proportions. The incidence is highest in metropolitan areas, fueled by a rising homicide rate. Our trauma center treats approximately 1,000 gunshot victims annually, and we have developed protocols that consider the characteristics of the inner-city population, which is notoriously difficult to follow. The upper extremity wounds we treat are generally complex, involving multiple structures, because the extent of injury may not be apparent on initial examination, thorough neurological and vascular evaluation is essential. Some patients can be treated as outpatients with oral antibiotics, copious irrigation and cleansing, and external stabilization of bony injuries, but most are admitted to the hospital for administration of intravenous antibiotics, thorough irrigation and meticulous debridement, and exploration of affected structures, including nerves. Arterial injuries are repaired at the initial debridement. Unstable fractures are immobilized with internal fixation either initially or in a delayed manner. Transected nerves noted on exploration are repaired after 7-10 days. All wounds are left open initially, with no packing. Early motion, vital for restoring function, is instituted postoperatively. The services of a clinical psychiatrist are useful in improving patient compliance and meeting patients' emotional needs.

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