Current concept| Volume 38, ISSUE 8, P1641-1650, August 2013

Management of Gunshot Wounds to the Hand: A Literature Review

  • Tolga Turker
    Corresponding author: Tolga Turker, MD, Division of Reconstructive and Plastic Surgery, University of Arizona Health Sciences Center, 1501 N. Campbell Ave., Room 4143C, Tucson, AZ 85724
    Division of Reconstructive and Plastic Surgery, University of Arizona Health Sciences Center, Tucson, AZ; Arizona Health Sciences Library, University of Arizona Health Sciences Center, Tucson, AZ
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  • Nicole Capdarest-Arest
    Division of Reconstructive and Plastic Surgery, University of Arizona Health Sciences Center, Tucson, AZ; Arizona Health Sciences Library, University of Arizona Health Sciences Center, Tucson, AZ
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Published:April 05, 2013DOI:
      Hand trauma resulting from firearms is becoming more common in civilian life. In the past, as in wartime, infection was a main source of concern following firearm-related hand injuries, whereas in current civilian life with modern medical care, infection rates are actually low for such injuries. As infection is now of lesser concern, the focus should shift to improve functional outcomes. This review summarizes available literature regarding the management of gunshot wounds to the hand, with particular focus on functional outcomes. In conducting this review, we found that there is not comprehensive information regarding management of gunshot wounds to the hand, and literature discussing functional recovery of the hand is limited. Given the current evidence related to management of gunshot wounds to the hand, we believe that early debridement, antibiotic treatment, reconstruction, and rehabilitation offer patients the best chance for full functional recovery.

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        • Kochanek K.D.
        • Xu J.
        • Murphy S.L.
        • et al.
        Deaths: final data for 2009.
        Natl Vital Stat Rep. 2011; 60: 11
        • Bartlett C.S.
        • Helfet D.L.
        • Hausman M.R.
        • et al.
        Ballistics and gunshot wounds: effects on musculoskeletal tissues.
        J Am Acad Orthop Surg. 2000; 8: 21-36
        • Duncan J.
        • Kettelkamp D.B.
        Low-velocity gunshot wounds of the hand.
        Arch Surg. 1974; 109: 395-397
        • Elton R.C.
        • Bouzard W.C.
        Gunshot and fragment wounds of the metacarpus.
        South Med J. 1975; 68: 833-843
        • Howland Jr, W.S.
        • Ritchey S.J.
        Gunshot fractures in civilian practice.
        J Bone Joint Surg Am. 1971; 53: 47-55
        • Chappell J.E.
        • Mitra A.
        • Weinberger J.
        • et al.
        Gunshot wounds to the hand: management and economic impact.
        Ann Plast Surg. 1999; 42: 418-423
        • Nathan R.
        The management of penetrating trauma to the hand.
        Hand Clin. 1999; 15 (vii): 193-199
        • Granberry W.M.
        Gunshot wounds of the hand.
        Hand. 1973; 5: 220-228
        • Thoresby F.P.
        • Darlow H.M.
        The mechanisms of primary infection of bullet wounds.
        Br J Surg. 1967; 54: 359-361
        • Wolf A.W.
        • Benson D.R.
        • Shoji H.
        • et al.
        Autosterilization in low-velocity bullets.
        J Trauma. 1978; 18: 63
        • Marcus N.A.
        • Blair W.F.
        • Shuck J.M.
        • et al.
        Low-velocity gunshot wounds to extremities.
        J Trauma. 1980; 20: 1061-1064
        • Nguyen V.
        • Wollstein R.
        Civilian gunshot wounds to the fingers treated with primary bone grafting.
        J Plast Reconstr Aesthet Surg. 2009; 62: e551-e555
        • Tian H.
        • Deng G.
        • Huang M.
        • et al.
        Quantitative bacteriological study of the wound track.
        J Trauma. 1988; 28 (Suppl): S215-S216
        • Raju S.
        Shotgun arterial injuries of the extremities.
        Am J Surg. 1979; 138: 421-425
        • Bilos Z.J.
        • Eskestrand T.
        External fixator use in comminuted gunshot fractures of the proximal phalanx.
        J Hand Surg Am. 1979; 4: 357-359
        • Gonzalez M.H.
        • Hall M.
        • Hall R.F.
        Low-velocity gunshot wounds of the proximal phalanx: Treatment by early stable fixation.
        J Hand Surg Am. 1998; 23A: 150-155
        • Simpson B.M.
        • Wilson R.H.
        • Grant R.E.
        Antibiotic therapy in gunshot wound injuries.
        Clin Orthop Relat Res. 2003; : 82-85
        • Holtom P.D.
        Antibiotic prophylaxis: current recommendations.
        J Am Acad Orthop Surg. 2006; 14: S98-S100
        • Kiehn M.W.
        • Mitra A.
        • Gutowski K.A.
        Fracture management of civilian gunshot wounds to the hand.
        Plast Reconstr Surg. 2005; 115: 478-481
        • Komurcu M.
        • Alemdaroglu B.
        • Kurklu M.
        • et al.
        Handgun injuries with metacarpal and proximal phalangeal fractures: early definitive treatment.
        Int Orthop. 2008; 32: 257-262
        • Struck R.L.
        • Gustilo R.B.
        Gunshot wounds to the extremities.
        Minn Med. 1975; 58: 559-562
        • Cziffer E.
        • Farkas J.
        • Turchányi B.
        Management of potentially infected complex hand injuries.
        J Hand Surg Am. 1991; 16: 832-834
        • Saint-Cyr M.
        • Miranda D.
        • Gonzalez R.
        • et al.
        Immediate corticocancellous bone autografting in segmental bone defects of the hand.
        J Hand Surg Br. 2006; 31: 168-177
        • Gonzalez M.H.
        • McKay W.
        • Hall Jr, R.F.
        Low-velocity gunshot wounds of the metacarpal: treatment by early stable fixation and bone grafting.
        J Hand Surg Am. 1993; 18: 267-270
        • Ordog G.J.
        • Sheppard G.F.
        • Wasserberger J.S.
        • et al.
        Infection in minor gunshot wounds.
        J Trauma. 1993; 34: 358-365
        • Phillips III, P.
        • Hansraj K.K.
        • Cox II, E.E.
        • et al.
        Gunshot wounds to the hand.
        Orthop Clin North Am. 1995; 26: 95-108
        • Brown P.W.
        War wounds of the hand revisited.
        J Hand Surg Am. 1995; 20: S61-S67
        • Bartlett C.S.
        Clinical update: gunshot wound ballistics.
        Clin Orthop Relat Res. 2003; : 28-57
        • Luce E.A.
        • Griffen W.O.
        Shotgun injuries of the upper extremity.
        J Trauma. 1978; 18: 487-492
        • Stromberg B.V.
        Management of low-velocity gunshot wounds of hand.
        South Med J. 1978; 71: 1087-1088
        • Zajic Z.
        • Micanovic V.
        • Papazoglu K.
        Gunshot injuries of the limbs (5 years of experience; 1970–1975) [in Serbian].
        Acta Chir Iugosl. 1976; 23: 229-238
        • Pereira C.
        • Boyd J.B.
        • Olsavski A.
        • et al.
        Outcomes of complex gunshot wounds to the hand and wrist a 10-year level I urban trauma center experience.
        Ann Plast Surg. 2012; 68: 374-377
        • Kakinoki R.
        • Ikeguchi R.
        • Matsumoto T.
        • et al.
        Reconstruction of a phalangeal bone using a vascularised metacarpal bone graft nourished by a dorsal metacarpal artery.
        Injury. 2008; 39: 25-28
        • Nalbantoglu U.
        • Gereli A.
        • Ucar B.Y.
        • et al.
        Treatment of metacarpal fractures with open reduction and low-profile plate and screw fixation [in Turkish].
        Acta Orthop Traumatol Turc. 2008; 42: 303-309
        • Stahl S.
        • Lerner A.
        • Kaufman T.
        Immediate autografting of bone in open fractures with bone loss of the hand: a preliminary report.
        Scand J Plast Reconstr Surg Hand Surg. 1999; 33: 117-122
        • Bach H.G.
        • Gonzalez M.H.
        • Hall Jr, R.F.
        Locked intramedullary nailing of metacarpal fractures secondary to gunshot wounds.
        J Hand Surg Am. 2006; 31: 1083-1087

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