inflicted gunshot hand wounds are common, usually
involving the nondominant hand. This man accidentally
disharged a clean fishing bang stick into the palm of
his nondominant hand. He had paresthesias involving the
adjacent sides of his middle and ring finger. He was
treated with immediate wound debridement and
reconstruction of the middle metacarpal with iliac crest
This case followed the school of thought that because this was a low energy gunshot type injury, the zone of injury could be defined well enough to proceed with immediate reconstruction - fewest operations, fastest recovery, best chance of best possible final result.
There are many other options, including delayed reconstruction. The fact that he had been spared significant nerve, vascular or tendon disruption made his chances of good result better than average regardless of the management path chosen.
|Click on each image for a larger picture|
|Entry and exit
|Middle and ring
metacarpal base fractures with pulverized middle
Contaminated tissue was excised.
|Nerve branches and
tendons were contused, but in continuity.
bicortical iliac crest graft incorporating
postop; bone graft incorporated, active motion
restored, recovery of sensation.
immediate gunshot reconstruction
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