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. 2008 Apr;32(2):257-62.
doi: 10.1007/s00264-006-0312-7. Epub 2007 Mar 20.

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

Mahmut Kömürcü  1 , Bahadir Alemdaroğlu, Mustafa Kürklü, Hüseyin Ozkan, Mustafa Basbozkurt
Affiliations

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

Mahmut Kömürcü et al. Int Orthop. 2008 Apr.

Abstract
in English, French

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.

Les blessures par armes à feu au niveau de la main entraînent des lésions tissulaires complexes. Le but de cette étude est de rapporter les résultats du traitement des fractures des phalanges proximales et des métacarpiens en fonction de la force du tir. Une analyse rétrospective de 51 fractures métacarpiennes et de 41 fractures des phalanges proximales sur 76 patients ont été traitées entre janvier 2001 et décembre 2004. Nous avons réalisé une fixation de première intention en urgence dans les 24 premières heures. Ces patients ont été évalués par la mobilité, l’aspect radiographique et le taux de complication. Le taux d’infection a été de 10,5% et les nécessités de reprises chirurgicales de 7%. Le groupe des patients traités par plaque a une mobilité plus importante que ceux traités par fixateurs externes. Le groupe des patients brochés a entraîné un taux important de réinterventions. Le groupe des patients greffés a bénéficié d’une bonne récupération de la mobilité et d’un taux de complication relativement bas. La majorité des blessures par armes à feu avec une vitesse de pénétration relativement lente permet à la plaie d’être relativement propre et permet également une fixation de la fracture et une greffe précoce ainsi qu’une reconstruction des tissus mous. Une ostéosynthèse par plaque et vis peut être associée avec un résultat fonctionnel bien meilleur que ceux bénéficiant d’une fixation plus aléatoire.

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Figures

Fig. 1
Fig. 1
Soft tissue necrosis developed by the reason of gun shot injury and the radiological appearance of proximal phalanx fracture caused by gun shot injury
Fig. 2
Fig. 2
Intra-operative clinical and radiological appearance of rubber band technique
Fig. 3
Fig. 3
The clinical appearances of cross-finger fascial flap and skin graft after operation
Fig. 4
Fig. 4
The radiologic appearances after postoperative six months
Fig. 5
Fig. 5
The functional appearance after six months
See this image and copyright information in PMC

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