Prophylactic Antibiotic Use in the Setting of Non-Operative, Low-Velocity Gunshot Wounds

The management of low-velocity gunshot-induced fractures (LGF), particularly regarding prophylactic antibiotic use, is widely debated. Recent studies have suggested no significant difference in infection rates between patients receiving prophylactic antibiotics for LGF and those who do not. This retrospective study compared infection rates between patients receiving prophylactic antibiotics and those who did not for non-operative, LGF between 2015 and 2020. Data were analyzed for variables including demographics, injury characteristics, and infection within 30 days. Of the 74 patients included, 6 (8.1%) developed infections. With the numbers available, no significant difference in infection rates could be detected (adjusted relative risk: 0.40, 95% confidence interval: 0.01 – 32.2, p = 0.684). An increased risk in males, current smokers and those without insurance was found. The similar infection rates observed between groups indicate that antibiotic use may be more selectively applied, potentially focusing on patients with specific risk factors. Further large-scale, prospective studies are needed to establish evidence-based guidelines. (Journal of Surgical Orthopaedic Advances 35(3):149–153, 2026)

Key words: gunshot, fractures, infection, antibiotic prophylaxis