In a prospective study, we assessed 38 consecutive gunshot fractures of the humeral shaft treated between 1 April 1990 and 30 June 1994. The average age was 34 (range, 16-60) years. Average follow-up was 31 (range, 8-50) months. Low-velocity fractures occurred in 35 patients. All fractures were comminuted and displaced. Nerve injuries (radial and/or median) occurred in eight and vascular injuries in three patients. All three vascular injuries had combined nerve injuries. The arteries and nerves were explored; only one artery was found severed and required repair; two arteries and all explored nerves were in continuity. All patients had minimal debridement, antibiotic therapy and stabilization of the fracture with an external fixator. The wounds healed by granulation in 27 patients; seven had secondary closure, and four had split skin grafts. The external fixator was left in place for 6-24 (average, 16) weeks. In 34 patients union occurred between 12 and 24 (average, 16) weeks. Two patients with delayed union required bone grafting. Nonunion occurred in two patients (5%). Full recovery of the nerve palsy without further intervention was observed in seven of the eight cases. Superficial pin track infection was present in five patients; two had deep wound sepsis, and one had bone sepsis. We recommend this treatment for low-velocity humeral shaft fractures.

The presumed mechanism of injury in the described fracture is one of asymmetrical axial compression. The fracture can be managed safely in a halo jacket.

Background: Posterior acromioclavicular dislocation is rare. Dislocation associated with fracture of the clavicle and simultaneous entrapment of the lateral end of the clavicle by trapezius muscle has not been reported. Posterior dislocation occurs frequently owing to forceful move of the scapula anteriorly and superiorly or from direct force applied to the lateral end of the clavicle and this may be associated with clavicular fracture. In acute dislocations, open reduction, internal joint stabilization and soft tissues reconstruction have been recommended. Case Study: Acute posterior dislocation occurred in a 32-year-old man. The lateral end of the clavicle was displaced posteriorly and inferiorly, and firmly entrapped in trapezius muscle. The clavicular fracture was undisplaced. The coracoclavicular ligaments were stretched but intact. Open reduction was secured with two smooth Kirschner wires. The disrupted soft tissues were repaired. The clavicular fracture was not explored. Shoulder movement started at 6 weeks. Wires were removed. 10 years later he had pain-free, unrestricted shoulder movement, and the radiographs showed wellreduced, essentially normal acromioclavicular joint. Conclusion: Open reduction, internal joint stabilization and soft tissue reconstruction will result in return and long lasting unrestricted pain-free function of the shoulder.