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. 2023 Dec;33(8):3711-3716.
doi: 10.1007/s00590-023-03611-0. Epub 2023 Jun 15.

Surgical management of distal humerus gunshot fractures: descriptive case series

Ntambue Kauta  1 , Alasdair Bott  2 , Edgar Tafadzwa Majirija  3 , Jean Pierre Du Plessis  4 , Basil Vrettos  5 , Sithombo Maqungo  6 , Stephen Roche  6
Affiliations

Surgical management of distal humerus gunshot fractures: descriptive case series

Ntambue Kauta et al. Eur J Orthop Surg Traumatol. 2023 Dec.

Abstract

Purpose: The purpose of this study was to report our 5 years surgical experience and the rate of neurovascular injury following gunshot fractures of the distal humerus in a in level-1 Trauma Centre in South Africa.

Methods: A retrospective case series of 25 consecutive adult gunshot injuries to the distal humerus. Demographic and injury data were extracted from clinical case notes and electronic operative records. Imaging archives were used to classify fractures according to the AO/OTA classification.

Results: Twenty-five male patients, with mean age of 32-years-old, sustained gunshot injuries to the distal humerus. Eleven patients had multiple gunshots. Forty-four percent of patients underwent Computed Tomography Angiography (CTA), 20% had confirmed brachial artery injury. Limbs with vascular injury were salvaged with arterial repair and external fixation. Fractures were extra-articular in 20 cases (80%). Nineteen fractures were classified as highly comminuted. Nerve injuries occurred in 52% and were all managed expectantly. Only 32% of patients attended follow-up beyond 3 months.

Conclusions: These are rare challenging injuries with high rates of neurovascular damage. This demographic of patients is poorly compliant with follow up highlighting the need for high-quality early care. Brachial artery injury should be excluded with CTA and can be managed with arterial repair and external fixation. All fractures in this series were surgically managed with conventional anatomical plate and screw fixation techniques. For nerve injury, we advocate expectant management.

Level of evidence: IV.

Keywords: Distal humerus fracture; Gunshot Injury; Nerve injury; Vascular injury.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Affected side, single versus multiple gunshot injury, and rate of neurovascular injuries
Fig. 2
Fig. 2
Ulnar nerve injury in patient with isolater A13.3 distal humeral fracture
Fig. 3
Fig. 3
Gunshot distal humerus with brachial artery injury treated with temporary external fixator
Fig. 4
Fig. 4
Pre-operative and post-operative radiographs of a gunshot distal humerus fracture treated with open reduction and internal fixation
See this image and copyright information in PMC

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