Open Hand Fracture by Gunshot

Abstract

Introduction: Open fractures (AF) produced by firearm bullets in the hands of civilians are rare in our environment, but they are the cause of long or permanent disability, with personal, social and economic impact.

Objective: To present the results of the treatment carried out on an open fracture due to a gunshot wound to the hand.

Case report: We report the case of a civilian security guard who, by mistake, shot himself with the 16-cartridge shotgun in palm region above the barrel. He had fractured the left carpal bones, exposed, grades III-B, according to Gustillo and Anderson classification and Type III according to the classification by firearm projectiles. The patient received clinical and surgical treatment, antibiotic therapy, and multiple cures in the operating room during 8 months. Stabilization was performed with an articulated external fixator (ORTOFIX®) for carpal arthrodesis and free skin graft by cosmetic surgery.

Conclusions: Treatment with arthrodesis in the carpal joint allowed the wrist to remain in a functional position, maintaining the digital clamp and the opposition of the thumb. The patient had a favorable clinical evolution and amputation was not necessary, which demonstrated the excellence of the procedures carried out.