Management of severe firearm injury of the hand in a precarious area

Abstract

Introduction: Gunshot injuries have been found to involve the extremities such as the upper extremity. We report a case of complex gunshot injury to the hand. Case report: A 40-year-old police man, right-handed. He was a victim of a point-blank gun attack. He had an open trauma of the right hand, associated with a penetrating wound of the right hypochondrium classified according to Red Cross: entry 2cm, exit 1cm, cavity +, fracture: 0, vessels: 0, metal (bullet): 0. The clinical, radiographical examination and surgical exploration showed: a fracture of the first metacarpal, a fracture of the second metacarpal and the first phalanx of the index finger, and a fracture of the first and second phalanx of the middle finger, a section of the extensor and flexor pollicis longus tendons of the thumb; a section of the superficial and deep flexor tendons of the index, middle, and ring fingers, a section of the extensor digitorum proprius and common tendons of the index finger; and a comminuted fracture of the first metacarpal with bone loss. Under general anesthesia, simultaneous multidisciplinary management was performed. At the 9-year follow-up: The hand was pain-free, the scar was flat, the right thumb was two centimeters shorter than the contralateral one, and the grip strength of the long fingers was satisfactory but slightly weaker than on the contralateral side. Finger flexion was complete. The QuickDASH score was 17/55. Conclusion: Complex hand injuries from firearms are rare outside of a war context. Their surgical management in a single procedure provides a satisfactory functional result.