Fracture of the Humeral Shaft Secondary to High-Velocity Gunshot (Machine Gun) Injury: A Case Report

Ki Won Lee; Joo-Yul Bae; Suk Kyu Lee

doi:10.12671/jkfs.2017.30.2.83

Journal List > J Korean Fract Soc > v.30(2) > 1038120

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee, Bae, and Lee: Fracture of the Humeral Shaft Secondary to High-Velocity Gunshot (Machine Gun) Injury: A Case Report

Case Report

Journal of the Korean Fracture Society 2017; 30(2): 83-88.

Published online: 18 April 2017

DOI: https://doi.org/10.12671/jkfs.2017.30.2.83

Fracture of the Humeral Shaft Secondary to High-Velocity Gunshot (Machine Gun) Injury: A Case Report

Ki Won Lee, M.D., Joo-Yul Bae, M.D., Suk Kyu Lee, M.D.

Department of Orthopaedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.

Correspondence to: Joo-Yul Bae, M.D. Department of Orthopaedic Surgery, Gangneung Asan Hospital, 38 Bangdong-gil, Sacheon-myeon, Gangneung 25440, Korea. Tel: +82-33-610-3245, Fax: +82-33-641-8050, qwonduf@gmail.com

Received 21 February 2017 Revised 27 February 2017 Accepted 27 February 2017

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

High-velocity gunshot injury (muzzle velocity greater than 609.6 m/s) is uncommon and primarily a military injury. Humerus shaft fracture, caused by a high-velocity gunshot, should be considered as a severe open fracture. The principles of treatment are immediate and aggressive irrigation, wide debridement, primary delayed wound closure, and broad-spectrum intravenous antibiotics. External fixation has been widely used for fracture fixation. We report a case of humerus shaft fracture secondary to high-velocity gunshot (machine gun) injury, with a literature review.

Keywords: Humerus, Fracture, Gunshot wound

Figures and Tables

Fig. 1

Exit wound of the right arm exhibits massive tissue and bone destruction—a characteristic of M-60 gunshot wound in which the bone is hit by M-60 bullets.

Fig. 2

(A) Initial radiograph shows comminuted humeral shaft fracture and multiple foreign bodies. (B) Initial computed tomography angiography scan.

Fig. 3

Photograph of radial nerve (arrow) injury.

Fig. 4

(A) Photograph of external fixation. (B) Radiograph after the removal of the bone and bullet fragments with external fixation.

Fig. 5

Photograph after anterior (A) and posterior (B) wound closure.

Fig. 6

(A) Intraoperative photograph shows open reduction and internal fixation with plate and screw, as well as autologous rib graft. (B) Postoperative radiograph shows open reduction and internal fixation with plate and screw, as well as autologous rib graft.

Fig. 7

Photograph of elbow and hand movement.

Fig. 8

Radiograph after implant removal.

Notes

^{Financial support} None.

^{Conflict of interests} None.

References

1. Oberli H, Frick T. The open femoral fracture in war: 173 external fixators applied to the femur (Afghanistan war). Helv Chir Acta. 1992; 58:687–692.

2. Zinman C, Norman D, Hamoud K, Reis ND. External fixation for severe open fractures of the humerus caused by missiles. J Orthop Trauma. 1997; 11:536–539.

3. Volgas DA, Stannard JP, Alonso JE. Current orthopaedic treatment of ballistic injuries. Injury. 2005; 36:380–386.

4. Dicpinigaitis PA, Koval KJ, Tejwani NC, Egol KA. Gunshot wounds to the extremities. Bull NYU Hosp Jt Dis. 2006; 64:139–155.

5. Sathiyakumar V, Thakore RV, Stinner DJ, Obremskey WT, Ficke JR, Sethi MK. Gunshot-induced fractures of the extremities: a review of antibiotic and debridement practices. Curr Rev Musculoskelet Med. 2015; 8:276–289.

6. Bartlett CS, Helfet DL, Hausman MR, Strauss E. Ballistics and gunshot wounds: effects on musculoskeletal tissues. J Am Acad Orthop Surg. 2000; 8:21–36.

7. Chang CH. Peripheral nerve injury of upper extremity by gunshot. J Korean Orthop Assoc. 1977; 12:187–192.

8. Hennessy MJ, Banks HH, Leach RB, Quigley TB. Extremity gunshot wound and gunshot fracture in civilian practice. Clin Orthop Relat Res. 1976; (114):296–303.

9. Wisniewski TF, Radziejowski MJ. Gunshot fractures of the humeral shaft treated with external fixation. J Orthop Trauma. 1996; 10:273–278.

10. Bercik MJ, Kingsbery J, Ilyas AM. Peripheral nerve injuries following gunshot fracture of the humerus. Orthopedics. 2012; 35:e349–e352.

TOOLS

Similar articles