Written by Millie Cossé
Duration of prophylactic antibiotic therapy was not found to be associated with likelihood of developing a fracture-related infection after GSW associated with bowel injury in this small retrospective study.
Bowel to bone – leave it alone?
If a bullet travels through bowel and strikes bone, causing a fracture, it’s probably going to lead to orthopedic infection… right? Maybe.
This retrospective study identified 140 patients across 6 years based on ICD-9/ICD-10 codes experiencing abdominal GSWs that caused both bowel injury and simultaneous fracture. Duration of prophylactic antibiotic therapy had no association with development of infection; however, it is important to note that only two patients in the cohort were diagnosed with fracture-related infection.
Also, remember that injuries from high velocity firearms (e.g. high-powered rifle, etc.) create a large path of devascularized tissue and are at high risk for infection. Fractures associated with injuries from these firearms should be treated as Gustilo type III fractures regardless of wound size due to the extensive soft tissue damage, contamination, and potential for vascular injury associated with this mechanism.
How does this change my practice?
This is a fairly small retrospective study with only two instances of the outcome of interest, so take these results with a grain of salt. Prophylactic antibiotic therapy for GSW injuries with hollow viscus perforation remains appropriate, and the ideal duration of treatment is unclear.
Source
Prophylactic antibiotics in gunshot fractures with concomitant bowel injury to prevent fracture-related infections and other infectious complications. Injury. 2025 Jun;56(6):112304. doi: 10.1016/j.injury.2025.112304. Epub 2025 Apr 8. PMID: 40279804
