Injury pattern, management and outcomes of gunshot-related fractures to the hand and wrist at a tertiary level trauma centre

Background

Civilian gunshot-related hand and wrist injuries are underreported in the literature. These injuries can carry significant financial, social and quality of life implications. This study aims to describe the injury pattern, management, complications and treatment outcomes of patients with gunshot-related injuries to the hand and wrist. A secondary objective was to identify risk factors for loss to follow-up.

Method

This retrospective descriptive study included all patients with gunshot-related injuries to the hand and wrist managed at a tertiary level hospital between January 2014 and December 2017. Patient demographics, injury data, management strategies, complications and functional ability were recorded. Associations between risk factors and loss to follow-up were investigated.

Results

A total of 144 patients (92% male) were included in the study (mean age 29 ± 9 years, range 10-62). Most injuries were sustained to the metacarpals (43%) and phalanges (41%). Conservative management (45%) and open reduction and internal fixation (ORIF) with Kirschner-wires (31%) were the most common treatment modalities. Complications included nonunion defined at nine months (4%), infection (1%) and range of motion loss (40%). Loss to follow-up was 51% and showed significant associations with injury site (p = 0.037) and type of definitive treatment (p = 0.042).

Conclusion

Gunshot-related injuries to the hand and wrist predominantly affected young males. A wide spectrum of injuries was identified with low complication rates to treatment. Stiffness and high loss to follow-up were common. Future research should focus on interventions to reduce loss to follow-up and improve functional outcomes. Level of evidence: 4