Functional recovery after civilian pelvic gunshot injuries: Insights from a 14-year retrospective study

This study aimed to evaluate long-term functional outcomes, fracture-related infection rates, and non-operative orthopaedic fracture management in civilian pelvic gunshot injuries caused by low-velocity firearms. A total of 47 patients with radiologically confirmed pelvic fractures treated between 2010 and 2024 at two tertiary referral hospitals were retrospectively analyzed. Only patients who met the eligibility criteria and had a minimum follow-up of 24 months were included. Demographic data, dominant primary fracture location, associated injuries, orthopaedic and non-orthopaedic treatment strategies, and complications were recorded. Functional outcomes were assessed using the Harris Hip Score (HHS). Exploratory univariable analyses were performed to evaluate factors associated with poor functional outcome. The majority of patients were male (89%) with a mean age of 32.4 years. The most common primary fracture locations were posterior pelvic ring injury (30%), anterior acetabular involvement (21%), anterior pelvic ring injury (21%), iliac wing injury (19%), and posterior acetabular involvement (9%). Gastrointestinal injury occurred in 47% of patients, and 64% underwent exploratory laparotomy. Orthopaedic fixation was performed in only 4% of cases. No fracture-related infections, osteomyelitis, or septic arthritis were observed. At a mean follow-up of 6.3 years, 68.1% of patients achieved good or excellent functional outcomes (HHS ≥ 80). In exploratory analyses, diabetes mellitus, smoking, and peripheral nerve injury were associated with poor functional outcome. Non-operative orthopaedic fracture management without routine fracture-site debridement or fixation was associated with favorable long-term functional outcomes in selected patients with low-velocity civilian pelvic gunshot injuries who met the eligibility criteria and had adequate follow-up. These findings should be interpreted cautiously because of the retrospective design, substantial exclusions, and potential attrition bias.