Fracture Management of Civilian Gunshot Wounds to the Hand

Abstract

Civilian gunshot wounds to the hand are typically caused by low-velocity weapons, which create a localized pattern of soft-tissue and bone injury that usually allows for early definitive treatment. A retrospective chart review of 72 patients treated for 98 gunshot wound fractures at an urban level I trauma center was conducted to evaluate the results of limited debridement and early definitive fracture fixation of urban gunshot wound fractures of the hand. The incidence of hand fractures, means of fracture fixation, number of operations, occurrence of infection, and level of patient compliance were determined. Twenty-nine fractures were managed definitively with reduction and splinting in the emergency department or intensive care unit. Sixty-eight fractures were treated surgically, at a mean of 2 days after injury. Eleven patients required more than one operation. The overall infection rate was 8 percent and was not influenced by the fracture fixation method. All infections were superficial and resolved with antibiotics alone. Thirty-nine percent of patients were lost to follow-up after hospital discharge and 85 percent of patients were lost to follow-up before documented fracture healing. Twenty-six percent of patients were lost to follow-up with a removable fixation device in place. Limited debridement and early definitive fracture fixation are associated with low rates of complications for typical civilian handgun wound fractures. Cases with extensive injury or contamination do require a staged approach to treatment. Poor patient compliance in the urban trauma setting should be expected and may affect the management plan.

Current Trends in the Management of Ballistic Fractures of the Hand and Wrist: Experiences of a High-Volume Level I Trauma Center

“…Kiehn et al concluded in their report that early internal fixation may have an advantage over external fixation in certain situations. 6 Counseling must be performed to ensure patient compliance, and we agree that an alternative technique should be considered in patients who are at risk for poor compliance. In all, 18.2% of patients underwent conservative management with irrigation and debridement with splinting in the emergency department.…”

Handgun injuries with metacarpal and proximal phalangeal fractures: early definitive treatment

“…Chappell et al advocate early fracture stabilisation and a low threshold for internal fixation for gunshot wounds to the hand, as conservative regimens cause a higher complication rate and higher economic impact [2]. Kiehn, Mitra and Gutowki have reported low infection rates with early definitive treatment for fractures without bone defects [8]. The infection rate in our cases is 10.5% and all of them responded to parenteral antibiotic therapy regimen without further complications.…”

Severe Hand Injuries Caused by a Mole Gun

“…Therefore, urgent irrigation of the wound, and debridement of all necrotic tissue, buckshot, and foreign and contaminated objects is critical in preventing infections before proceeding with reconstruction. 8,9 Patients usually undergo surgery within 72 hours for closure of bone, tendon, nerve, and soft tissue-skin defects. Repair of all available defects is completed in the same session, and the patients are admitted to hospital for a prolonged period (usually 21 days) and receive active and passive exercise programs, paraffin baths, hot and cold baths, and anti-edema therapy.…”