{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T01:48:19Z","timestamp":1790819299079,"version":"4.1.0"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5]]},"abstract":"\n OBJECTIVES:<\/jats:title>\n To report the injury profile of gunshot wounds (GSWs) to the humerus along with treatment, fracture-related infection (FRI), and nonunion.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Retrospective review.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Multicenter, 12 academic hospitals.<\/jats:p>\n <\/jats:sec>\n \n Patient Selection Criteria:<\/jats:title>\n All patients \u226518 years old who presented to the emergency room with GSW-related humerus fractures (Orthopaedic Trauma Association classifications 11\u201313, types A-C) were included from January 2016 to October 2021. Patients were compared based on surgical management (SM) and nonsurgical management (NoSM).<\/jats:p>\n <\/jats:sec>\n \n Outcome Measures and Comparisons:<\/jats:title>\n Data on patient demographics, injury presentation, treatment received, and outcomes including FRI and nonunion were collected. FRI was split into confirmatory and suggestive diagnoses. Multivariable logistic regression evaluated differences between the SM and NoSM groups in FRI after controlling for indicators of injury severity.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n Six hundred fifty-four patients were included with a mean age of 31 years (range: 18\u201374 years). Five hundred seventy-five patients (88%) were male, and 512 (79%) were Black or African American. Intra-articular fractures were more likely to be managed surgically (SM: 33.4%, NoSM: 17%,\n P<\/jats:italic>\n < 0.0001). The rate of vascular injury was significantly higher in SM patients (SM: 16.8%, NoSM: 5.4%,\n P<\/jats:italic>\n < 0.001); this was also true for nerve injury (SM: 45.6%, NoSM: 23.9%,\n P<\/jats:italic>\n < 0.0001). Among all 654 patients, there was a significant difference in confirmatory FRI (SM: 5.4%, NoSM: 0.4%,\n P<\/jats:italic>\n = 0.004) and suggestive FRI (SM: 19.9%, NoSM: 4.4%,\n P<\/jats:italic>\n < 0.0001). In the subgroup of 307 patients with at least 90 days of follow-up, a significant difference was observed in suggestive FRI (SM: 22.5%, NoSM: 2.4%,\n P<\/jats:italic>\n < 0.0001), but not in confirmatory FRI (SM: 6.8%, NoSM: 1.2%,\n P<\/jats:italic>\n = 0.080). The rate of nonunion did not differ significantly between groups in the full cohort (SM: 8.4%; NoSM: 5.3%,\n P<\/jats:italic>\n = 0.148) and subgroup with at least 90 days of follow-up (SM: 14.4%; NoSM: 12.9%,\n P<\/jats:italic>\n = 0.739). After controlling for indicators of injury severity, the SM group had a significantly higher odds of suggestive FRI than the NoSM group both in the overall cohort (adjusted odds ratio = 2.54; 95% confidence interval: 1.14\u20135.64;\n P<\/jats:italic>\n = 0.023) and among patients with at least 90 days of follow-up (adjusted odds ratio = 5.62; 95% confidence interval: 1.22\u201325.8;\n P<\/jats:italic>\n = 0.027).\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n In this study, humerus GSWs managed with surgery were associated with a higher prevalence of suggestive FRI, vascular injury, and nerve injury than GSWs managed without surgery; management (surgery vs. no surgery) was not associated with risk of nonunion.<\/jats:p>\n <\/jats:sec>\n \n LEVEL OF EVIDENCE:<\/jats:title>\n Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/bot.0000000000003142","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T18:00:17Z","timestamp":1767117617000},"page":"262-268","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Treatment and Outcomes for Gunshot Wound Humerus Fractures: A Multicenter Analysis"],"prefix":"10.1097","volume":"40","author":[{"given":"Adam","family":"Haydel","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Louisiana State University Health Sciences Center and University Medical Center, New Orleans, LA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2466-0815","authenticated-orcid":false,"given":"Eleanor","family":"Christianson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Baum","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Louisiana State University Health Sciences Center and University Medical Center, New Orleans, LA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tevyn","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Louisiana State University Health Sciences Center and University Medical Center, New Orleans, LA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Hartline","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nainisha","family":"Chintalapudi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Atrium Health-Carolinas Medical Center, Charlotte, NC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhav","family":"Karunakar","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Atrium Health-Carolinas Medical Center, Charlotte, NC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chirag","family":"Soni","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Eskenazi Health, Indianapolis, IN;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke A.","family":"Lopas","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Eskenazi Health, Indianapolis, IN;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nd\u00e9ye F.","family":"Guiss\u00e9","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna N.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah C.","family":"Kurkowski","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Claude Sagi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon-Luc","family":"Poirier","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohan","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suhas P.","family":"Dasari","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Washington, Harborview Medical Center, Seattle, WA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonah","family":"Hebert-Davies","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Washington, Harborview Medical Center, Seattle, WA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W.","family":"Rutz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clay A.","family":"Spitler","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley J.","family":"Lauck","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher Quincy","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Stanford University, Redwood City, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Ivanov","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Stanford University, Redwood City, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew T.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of North Carolina School of Medicine, Chapel Hill, NC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mubinah","family":"Khaleel","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, MO; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J.","family":"Della Rocca","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, MO; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Leonardi","sequence":"additional","affiliation":[{"name":"Department of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0100-3927","authenticated-orcid":false,"given":"Peter C.","family":"Krause","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Louisiana State University Health Sciences Center and University Medical Center, New Orleans, LA;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20260420","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.jamcollsurg.2020.06.022","article-title":"National trends and cost burden of surgically treated gunshot wounds in the US","volume":"231","author":"Dobaria","year":"2020","journal-title":"J Am Coll Surg"},{"key":"R3-20260420","doi-asserted-by":"crossref","first-page":"e301","DOI":"10.5435\/JAAOS-D-17-00676","article-title":"Gunshot wounds to the upper extremity","volume":"27","author":"Omid","year":"2019","journal-title":"J Am Acad Orthop Surg"},{"key":"R4-20260420","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/00005373-199502000-00029","article-title":"Hospital costs of firearm injuries","volume":"38","author":"Ordog","year":"1995","journal-title":"J Trauma"},{"key":"R5-20260420","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1007\/s43465-020-00299-w","article-title":"High velocity gunshot fractures of humerus: results of primary plate osteosynthesis","volume":"55","author":"Kumar","year":"2021","journal-title":"Indian J Orthop"},{"key":"R6-20260420","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.5435\/JAAOS-D-24-01073","article-title":"Contemporary management of proximal humeral fractures","volume":"33","author":"Stockwell","year":"2025","journal-title":"J Am Acad Orthop Surg"},{"key":"R7-20260420","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.otsr.2018.11.002","article-title":"Treating fractures in upper limb gunshot injuries: the Cape Town experience","volume":"105","author":"Engelmann","year":"2019","journal-title":"Orthop Traumatol Surg Res"},{"key":"R8-20260420","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1097\/BOT.0000000000002491","article-title":"Complications are infrequent after humeral shaft fractures due to low-energy gunshot injuries","volume":"37","author":"Cho","year":"2023","journal-title":"J Orthop Trauma"},{"key":"R9-20260420","doi-asserted-by":"crossref","first-page":"e307","DOI":"10.3928\/01477447-20140225-66","article-title":"Civilian gunshot injuries of the humerus","volume":"37","author":"Vaidya","year":"2014","journal-title":"Orthopedics"},{"key":"R10-20260420","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.injury.2017.08.040","article-title":"Fracture-related infection: a consensus on definition from an international expert group","volume":"49","author":"Metsemakers","year":"2018","journal-title":"Injury"},{"key":"R11-20260420","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"R12-20260420","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"key":"R13-20260420","doi-asserted-by":"crossref","first-page":"686","DOI":"10.2106\/JBJS.J.00845","article-title":"Distal humeral fractures in adults","volume":"93","author":"Nauth","year":"2011","journal-title":"J Bone Joint Surg Am"},{"key":"R14-20260420","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.jse.2008.06.005","article-title":"A multicenter, prospective, randomized, controlled trial of open reduction--internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients","volume":"18","author":"McKee","year":"2009","journal-title":"J Shoulder Elbow Surg"},{"key":"R15-20260420","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1302\/2058-5241.5.190050","article-title":"Distal humerus nonunion: evaluation and management","volume":"5","author":"Vauclair","year":"2020","journal-title":"EFORT Open Rev"},{"key":"R16-20260420","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/00005131-200301000-00006","article-title":"Adult distal humeral metaphyseal fractures: epidemiology and results of treatment","volume":"17","author":"Robinson","year":"2003","journal-title":"J Orthop Trauma"},{"key":"R17-20260420","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1093\/milmed\/168.9.694","article-title":"Treatment results for open comminuted distal humerus intra-articuler fractures with Ilizarov circular external fixator","volume":"168","author":"K\u00f6m\u00fcrc\u00fc","year":"2003","journal-title":"Mil Med"},{"issue":"Suppl 1","key":"R18-20260420","doi-asserted-by":"crossref","first-page":"Sa13","DOI":"10.1016\/S0020-1383(98)00099-0","article-title":"Humeral fracture secondary to civilian gunshot injury","volume":"29","author":"Joshi","year":"1998","journal-title":"Injury"},{"key":"R19-20260420","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1097\/00005131-199605000-00008","article-title":"Gunshot fractures of the humeral shaft treated with external fixation","volume":"10","author":"Wisniewski","year":"1996","journal-title":"J Orthop Trauma"},{"key":"R20-20260420","doi-asserted-by":"crossref","first-page":"e70068","DOI":"10.1111\/iwj.70068","article-title":"Risk factors for surgical site infections after orthopaedic surgery: a meta-analysis and systematic review","volume":"22","author":"Liu","year":"2025","journal-title":"Int Wound J"},{"key":"R21-20260420","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1097\/BOT.0000000000000960","article-title":"Fracture site mobility at 6 weeks after humeral shaft fracture predicts nonunion without surgery","volume":"31","author":"Driesman","year":"2017","journal-title":"J Orthop Trauma"},{"key":"R22-20260420","doi-asserted-by":"crossref","first-page":"469","DOI":"10.2106\/JBJS.20.00348","article-title":"The fallacy of follow-up: when orthopaedic trauma patients actually return to clinic","volume":"103","author":"Agel","year":"2021","journal-title":"J Bone Joint Surg Am"},{"key":"R23-20260420","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1097\/BOT.0000000000000346","article-title":"Loss of follow-up in orthopaedic trauma: who is getting lost to follow-up?","volume":"29","author":"Zelle","year":"2015","journal-title":"J Orthop Trauma"}],"container-title":["Journal of Orthopaedic Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/BOT.0000000000003142","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T16:40:55Z","timestamp":1786034455000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/BOT.0000000000003142"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":22,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/bot.0000000000003142","relation":{},"ISSN":["0890-5339","1531-2291"],"issn-type":[{"value":"0890-5339","type":"print"},{"value":"1531-2291","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"2025-11-26","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}