Outcomes in Ballistic Injuries to the Hand: Fractures and Nerve/Tendon Damage as Predictors of Poor Outcomes

Abstract

Background: Gunshot injuries can be devasting, regardless of their location. However, ballistic injuries involving the upper extremity have not been thoroughly investigated. The goal of this study is to evaluate the injury patterns and outcomes of patients who sustained gunshot injuries to the hand. Methods: A retrospective chart review of patients with gunshot injuries to the upper extremity at a single, level 1 trauma center between January 2016 and December 2017 was performed. Patient demographics and mechanisms of injuries were reviewed. The injury patterns, location, tendon/nerve involvement, and bony involvement were analyzed. Surgical interventions and long-term outcomes were reviewed. Outcomes were compared using the presence of fractures and nerve/tendon injuries as independent variables. Results: In all, 32 patients met our inclusion criteria. Of these, 15 patients had gunshots to the hand, 10 patients to the fingers, and 7 patients involving both the finger and hand. In patients with isolated hand injuries, 60% had fractures and 53% had nerve/tendon injuries. The presence of fractures was associated with a 7.9-fold increase in tendon and nerve injuries ( P = .032). Patients who sustained tendon/nerve injuries had significantly higher rates of permanent disability ( P = .01). The presence of a fracture leads to a higher likelihood of long-term complications, although not statistically significant ( P = .13). Conclusion: Ballistic injuries to the hand are frequently associated with fractures and neurovascular and tendon injuries. The presence of fractures is associated with a higher incidence of nerve and tendon injuries. Involvement of these structures is linked to an increased risk of long-term disability.

Upper Extremity Ballistic Nerve Injury

“…Civilian firearm injuries are now the leading cause of mortality in children and men younger than 40 years, and they account for an estimate of 60,000 to 75,000 visits to the emergency department every year 1-5 . With a high density of vital structures, the upper extremity (UE) is more prone to sustaining tendon, nerve, and arterial injuries 6 . Peripheral nerve injuries can occur from either a direct injury from the bullet itself (permanent cavity) or the shock-wave (temporary cavity) created by the bullet.…”