Low-velocity gunshot wounds of the metacarpal: Treatment by early stable fixation and bone grafting

Gonzalez, Mark H.; McKay, William F.; Hall, R

doi:10.1016/0363-5023(93)90359-b

Cited by 52 publications

(36 citation statements)

References 4 publications

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“…[24] The use of miniplates is reserved for fractures with comminution, bone loss and in cases of complex hand trauma. [10,12,13,16,27,30,31,34,48] Tension band wiring has also been considered by some authors for fixation of these fractures. [3,31] Melone cautioned against indiscriminate use of rigid internal fixation using plates and screws or tension band wires as it is exceedingly difficult in small bones with delicate soft tissue envelope.…”

Section: Surgical Techniquementioning

confidence: 99%

“…[2][3][4][5] While there is universal agreement over the management of undisplaced fractures by non-operative means, a varied opinion exists regarding the amount of acceptable volar angulation for non-operative management. [2][3][4][5][6][7][8][9]17,22,27,32,38,[41][42][43][44][45] Various reports suggest that it is almost impossible to maintain the reduction by non-operative means. [7,9,20,21,28,37,43,46] This leads to persistent deformity and morbidity in almost every case of displaced fifth metacarpal neck fracture treated non-operatively.…”

Section: Introductionmentioning

confidence: 99%

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“Bouquet technique” for displaced boxers fracture: Surgical technique and outcomes in143 consecutive cases

Memon

Patankar

Nagori

2018

Int Jour of Biomed Res

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Background: Fifth metacarpal neck fractures, also known as Boxer's fractures, commonly occur as a result of axial impact on a clenched fist. There is no agreement over the optimum management of undisplaced boxers fracture. We present the results of treatment by a Bouquet technique, described by Foucher in 143 consecutive cases of displaced fifth metacarpal neck fractures. Methods: We retrospectively reviewed our records for 143 consecutive cases of fifth metacarpal neck fractures treated with Bouquet technique. Clinical and radiological evaluation was done at 6 weeks, 12 weeks and 6 months. Total active motion of the fifth digit, radiography and complications if any were noted. Results: Of 143 cases, there were 113 cases with closed reduction and 30 with open reduction. Radiological union was achieved in 140 cases. Remaining 3 were lost to follow up. Good to excellent result was achieved in 95% cases. Seven cases developed bursitis at the K-wire entry site which required k-wire removal. Conclusion:The technique of flexible antegrade intramedulary nailing of fifth metacarpal neck fractures is simple, safe, soft tissue sparing, minimally invasive technique giving excellent functional and cosmetic results with minimal complications.

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Section: Surgical Techniquementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“Bouquet technique” for displaced boxers fracture: Surgical technique and outcomes in143 consecutive cases

Memon

Patankar

Nagori

2018

Int Jour of Biomed Res

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“…Similar disagreements on debridement policies were seen with hand fractures, which comprised four out of the 14 studies involving operative patients [28,29,34,35]. Specifically, Gonzalez reviewed 49 patients with 64 fractures of the metacarpus that underwent early irrigation and superficial debridement in the emergency room with subsequent definitive internal fixation and bone-grafting 1-7 days later with primary closure of wound [28].…”

Section: Debridement In Low-velocity Non-operative Fracturesmentioning

confidence: 99%

“…Out of the five studies that included mixed operative and non-operative patients [10,12,13,24,25], four recommended superficial debridement [10,12,24,25] with the last study from Brettler et al advocating for lavage in lieu of formal debridement [13]. (Table 2) [18][19][20][26][27][28][29]. Out of 14 studies that treated all patients operatively for fracture stabilization, eight used superficial debridement [19,20,[27][28][29][32][33][34], four incorporated extensive debridement in the operating room [18,26,31,35], and two used no debridement as part abx antibiotics, fx fractures, h hours, R retrospective, P prospective of the treatment algorithm [16,30].…”

Section: Debridement In Low-velocity Non-operative Fracturesmentioning

confidence: 99%

“…Out of 14 studies that treated all patients operatively for fracture stabilization, eight used superficial debridement [19,20,[27][28][29][32][33][34], four incorporated extensive debridement in the operating room [18,26,31,35], and two used no debridement as part abx antibiotics, fx fractures, h hours, R retrospective, P prospective of the treatment algorithm [16,30]. In all, 517 fractures comprised these 14 studies, with 50 fractures treated with extensive debridement, 412 treated with superficial debridement, and 105 fractures treated without debridement [16,[18][19][20][27][28][29][30][31][32][33][34][35]. Infection rates for these groups are 4 % (2/50) for extensive debridement, 5.6 % (23/412) for superficial debridement, and 1.8 % for no debridement.…”

Section: Debridement In Low-velocity Non-operative Fracturesmentioning

confidence: 99%

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Gunshot-induced fractures of the extremities: a review of antibiotic and debridement practices

Sathiyakumar

Thakore

Stinner

et al. 2015

Curr Rev Musculoskelet Med

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The use of antibiotic prophylaxis and debridement is controversial when treating low-and high-velocity gunshotinduced fractures, and established treatment guidelines are currently unavailable. The purpose of this review was to evaluate the literature for the prophylactic antibiotic and debridement policies for (1) low-velocity gunshot fractures of the extremities, joints, and pelvis and (2) high-velocity gunshot fractures of the extremities. Low-velocity gunshot fractures of the extremities were subcategorized into operative and nonoperative cases, whereas low-velocity gunshot fractures of the joints and pelvis were evaluated based on the presence or absence of concomitant bowel injury. In the absence of surgical necessity for fracture care such as concomitant absence of gross wound contamination, vascular injury, large soft-tissue defect, or associated compartment syndrome, the literature suggests that superficial debridement for low-velocity ballistic fractures with administration of antibiotics is a satisfactory alternative to extensive operative irrigation and debridement. In operative cases or those involving bowel injuries secondary to pelvic fractures, the literature provides support for and against extensive debridement but does suggest the use of intravenous antibiotics. For high-velocity ballistic injuries, the literature points towards the practice of extensive immediate debridement with prophylactic intravenous antibiotics. Our systematic review demonstrates weak evidence for superficial debridement of low-velocity ballistic fractures, extensive debridement for high-velocity ballistic injuries, and antibiotic use for both types of injury. Intra-articular fractures seem to warrant debridement, while pelvic fractures with bowel injury have conflicting evidence for debridement but stronger evidence for antibiotic use. Given a relatively low number of studies on this subject, we recommend that further highquality research on the debridement and antibiotic use for gunshot-induced fractures of the extremities should be conducted before definitive recommendations and guidelines are developed.

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Complete return of function after a rare penetrating injury of the hand

Nanhekhan¹,

Kon

2001

Eur J Plast Surg

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Low-velocity gunshot wounds of the metacarpal: Treatment by early stable fixation and bone grafting

Cited by 52 publications

References 4 publications

“Bouquet technique” for displaced boxers fracture: Surgical technique and outcomes in143 consecutive cases

“Bouquet technique” for displaced boxers fracture: Surgical technique and outcomes in143 consecutive cases

Gunshot-induced fractures of the extremities: a review of antibiotic and debridement practices

Complete return of function after a rare penetrating injury of the hand

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