Surgical debridement of low velocity ballistic traumatic arthrotomy did not reduce rates of early wound infection or septic arthritis

Sep 30, 2026

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Purpose: Compare incidence of ballistic wound infection and septic arthritis after operative versus nonoperative management of low-velocity ballistic traumatic arthrotomy of a major or intermediate joint. Methods: Retrospective cohort of consecutive adults treated within 24 h of injury at a Level 1 Trauma Center (2019–2023), identified from an orthopedic consult registry and analyzed with Fisher’s exact test using Šidák correction. Results: No significant differences in baseline factors or in ballistic wound infection (2.4% vs 5.7%, p=0.830) or septic arthritis (4.8% vs 8.5%, p=0.995) between antibiotic alone and formal surgical debridement with irrigation. Conclusion: Formal surgical debridement offered no incremental benefit over antibiotics alone.

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European Journal of Orthopaedic Surgery & Traumatology (2026) 36:68 [https://doi.org/10.1007/s00590-025-04648-z](https://doi.org/10.1007/s00590-025-04648-z) RESEARCH Surgical debridement of low velocity ballistic traumatic arthrotomy did not reduce rates of early wound infection or septic arthritis Vishal S. Patel1 · Max Yang1 · Andrew Duong1 · Soroush Shabani1 · Daniel Rusu1 · Joseph T. Patterson1 Received: 22 September 2025 / Accepted: 14 December 2025 © The Author(s) 2026 Abstract Purpose To compare the incidence of ballistic wound infection and septic arthritis after operative versus nonoperative management oflow-velocity ballistic traumatic arthrotomy of a major or intermediate joint. Methods A retrospective cohort of consecutive adults treated within 24 h of injury at one Level 1 Trauma Center of lowvelocity ballistic traumatic arthrotomy of the shoulder, elbow, wrist, hip, knee, or ankle from 2019 to 2023 was identified from an orthopedic consult registry. Treatment was classified as antibiotic therapy with or without formal surgical debridement with joint irrigation. The primary outcomes of ballistic wound infection and septic arthritis were compared by Fisher’sexact test with Šidák correction. Results Five hundred seventy-eight patients with ballistic extremity injuries were screened. Seventy-seven patients met inclusion criteria. Thirty-five patients (45.5%) received operative care and 42 patients (54.5%) received nonoperative care. No significant differences were observed between treatment groups by age, sex, race/ethnicity, body mass index, area deprivation index (ADI), insurance status, medical comorbidities, the joint involved, or antibiotic regimen. No statistically significant difference in the rates of ballistic wound infection (2.4% vs. 5.7%, p = 0.830) or septic arthritis (4.8% vs. 8.5%, p = 0.995) were found between antibiotic therapy alone versus formal surgical debridement with joint irrigation. Conclusion Formal surgical debridement of ballistic traumatic arthrotomy of large and intermediate joints did not provide incremental benefit over antibiotic therapy alone. Level of evidence Therapeutic level IV. Keywords Arthrotomy · Ballistic · Gunshot · Debridement · Septic arthritis · Surgical site infection 􀀍 Joseph T. Patterson [josephp7@usc.edu](josephp7@usc.edu) Vishal S. Patel [vspatel@usc.edu](vspatel@usc.edu) Max Yang [maxyang@usc.edu](maxyang@usc.edu) Andrew Duong [andrew.mq.duong@gmail.com](andrew.mq.duong@gmail.com) Soroush Shabani [sshabani@usc.edu](sshabani@usc.edu) Daniel Rusu [drusu@usc.edu](drusu@usc.edu) 1 Keck School of Medicine of University of Southern California, Los Angeles, USA Introduction Low-velocity ballistic injuries from small firearms were the mechanism of injury for over 46,728 deaths across the United States (U.S) in 2023 [1] . The incidence of ballistic fractures has increased more than 500% from the year 2000 to 2019 across the U. S. and a similar increase has been seen in Europe [2, 3] . Ballistic injuries to the extremities often produce complex fractures, soft tissue damage, and joint injuries. A ballistic traumatic arthrotomy occurs when a projectile breaches the capsule of a joint and may carry an increased risk of septic arthritis due to contamination of the immune privileged articular space with skin flora and foreign material [4] . Septic arthritis may have severe consequences including permanent loss of function in 25–50% of cases and even mortality related to secondary systemic infection reported in up to 10% of patients [5, 6]. The gold standard of treatment 1 3 for blunt and penetrating traumatic arthrotomy of large and intermediate sized joints is incisional debridement and irrigation of the joint to remove contaminants [7–9] . Absolute indications for surgical management of ballistic traumatic arthrotomies included open fractures with contaminated tissue requiring extensive debridement not feasible at the bed

FAQs

What was the study’s main purpose?

To compare the incidence of ballistic wound infection and septic arthritis after operative versus nonoperative management of low-velocity ballistic traumatic arthrotomy of major or intermediate joints.

How were treatments classified in the study?

Treatment was classified as antibiotic therapy with or without formal surgical debridement with joint irrigation.

Did surgical debridement reduce early infection or septic arthritis rates?

No. There were no statistically significant differences in ballistic wound infection or septic arthritis rates between antibiotic therapy alone and formal surgical debridement with joint irrigation.

Sep 30, 2026

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