Gunshot wounds to the hand: Management and economic impact

Low-velocity firearms represent the majority of civilian gunshot wounds to the hand, yet much of the literature is based on high-velocity injuries. Th e authors reviewed their treatment regimen for civilian gunshot wounds to t he hand and offer a treatment algorithm that emphasizes early debridement a nd fracture stabilization. They also address the economic impact on society . The authors reviewed 121 fractures in 90 patients with gunshot wounds to the hand treated at an urban trauma center during the last 5 years. All pat ients were managed with irrigation and debridement, elevation, intravenous antibiotics, and early fracture stabilization. Sixty fractures were managed with rigid internal or external fixation: Kirshner wires (26%), miniplates (16%), and external fixation (8%), Fifty-six fractures were managed with c losed reduction. Five fractures required amputation. There was one subseque nt infection and two late amputations. The cost of hospitalization and oper ative care was-more than $1.7 million. For gunshot wounds to the hand the a uthors advocate immediate irrigation and debridement, intravenous antibioti cs, early fracture stabilization, and a low threshold for internal fixation . This regimen is supported-by their low infection and complication rates.