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

Abstract

Most gunshot injuries to the hand involve a combination of tissue types. The goal of this study is to report the results of early definitive treatment in extra-articular metacarpal and proximal phalangeal fractures due to low velocity gunshot wounds and to analyse their outcomes. A retrospective analysis of 51 metacarpal and 41 proximal phalangeal fractures of 76 patients due to low velocity gunshot wounds treated between January 2001 and December 2004 was carried out. We applied acute fixation in the first 24 hours. The patients were evaluated with total active motion scores, radiographic control, complication rate and the need for revision surgery. The infection frequency was 10.5% and the need for a revision surgery was 7%. The plate fixation group had significantly higher total active motion scores than the external fixation group. The K wire group had the highest revision rate. The bone grafting group was associated with good total active motion scores and low complication rates. The majority of the low velocity gunshot injuries are surgically clean wounds which allow not only early fracture fixation, but also early bone grafting and soft tissue reconstruction. Plate and screw fixation is associated with significantly better functional outcomes than the minimal fixation group.

A strong reconstruction option for tissue loss on hand and wrist due to firearm injury in the Syrian war

“…In addition to a long hospital stay, there are some restrictive conditions, such as the need for high-level surgical skills with a well-organized patient care team. [ 19 ]…”

“…In addition to a long hospital stay, there are some restrictive conditions, such as the need for high-level surgical skills with a well-organized patient care team. [19] Distal-based fasciocutaneous flaps on the forearm have proven to be simple use, versatile and reliable flaps; they can be used to reconstruct a wide variety of soft tissue defects of the hand. [20] In this sense, PIF has aroused increasing interest in plastic hand surgeons and is one of the most frequently used skin flaps in reconstructive surgery.…”

An Evidence-Based Approach to Metacarpal Fractures

“…This problem has by no means been solved. Kömü rcü et al found good results with both plating and external fixation in both phalanges and metacarpals injured with low-velocity gunshots (Level IV Evidence), 16 while Bach et al demonstrated acceptable results using a locked intramedullary nail in the metacarpal with missing bone (Level V Evidence). 17 In terms of other methods of metacarpal fixation, acceptable results have been demonstrated with a variety of other techniques.…”

Gunshot Fractures to the Limbs: A Review of Fixation Methods

“…Kiehn [19], in a restrospective descriptive study, pointed immediate definitive fixation methods and the best choice for definitive fixation in hand fractures by low energy firearms. Komurcu [20] compared osteosynthesis with plate and fixation with kirschner wires in hand fractures by low velocity firearms, in a total of 76 patients, 51 metacarpal fractures and 41 proximal phalangeal fractures. There were no significant differences between the methods used.…”