Epidemiology and risk factors for loss to follow-up following operatively treated femur ballistic fractures

Introduction: Evidence regarding recommendations for treatment of ballistic fractures remains limited. This paucity of literature has largely been attributed to gunshot wound victims being a difficult popula-tion to study secondary to loss to follow-up. The purpose of this study was to examine the epidemiology of operatively treated ballistic femur fractures at our institution, the frequency of outpatient follow-up and risk factors for loss to follow-up. Methods: Inpatient consults from 2013-2018 were queried for femoral gunshot wounds treated oper-atively. Cases without internal or external fixation were excluded from the study. Postoperative visits where a patient was hospitalized or had expired were excluded from the analysis. Demographic informa-tion, length of hospital stay, and operative characteristics were compared for different fixation methods and examined as risk factors for loss to follow-up. Results: A total of 194 patients met inclusion criteria. The average age was 27 years old and 94% of the patients were male. Patient's stayed a median of 5 days post-operatively with patients treated with exter-nal fixation staying longer than internal fixation (14 days vs 5 days p = 0.01). 9.3% of ballistic fractures had a concomitant vascular injury necessitating repair. 70.4% of patients attended their 2-week postoperative visit, 55.7% of patients attended their 6 week follow-up visit and 31.3% attended their 3 month follow-up visit. Risk factors for loss to follow-up at 3 month visit included younger age (p = 0.028), decreased hospital length of stay (p = 0.025) and intramedullary fixation (p = 0.0 0 015). Discussion and conclusion: This study reinforces the difficulty of studying ballistic fractures secondary to loss to follow-up. Younger age, shorter hospital stays and intramedullary fixation increased the risk for loss to follow-up at 3 months. (c) 2021 Elsevier Ltd. All rights reserved.