Outpatient management of low-velocity gunshot-induced fractures

This prospective study evaluated the efficacy of an outpatient management p rotocol for patients with a gunshot-induced fracture with a stable, nonoper ative configuration. Forty-one patients (44 fractures) with a grade I or II open, nonoperative fracture secondary to a low-velocity missile comprised the study population. Patients were treated by a standard protocol, which i ncluded 1 g of cefazolin administered in the emergency room and a 7-day cou rse of oral cephalexin. Follow-up visits were performed until complete woun d and fracture healing were achieved. Thirty-two (78%) of 41 patients underwent full followup. Average follow-up was 5.2 months. One (2.8%) fracture (distal fibula) developed a superficial infection, which responded to an additional week of oral antibiotics, and no patient developed a deep infection. There was 1 delayed union and 2 pati ents with painful retained shrapnel. These results demonstrate that patient s with stable, low-velocity, gunshot-induced fractures can be managed effec tively and safely on an outpatient basis using this protocol.