枪击相关掌骨骨折：一项回顾性研究和单一城市中心经验

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2025-08-12 DOI:10.1016/j.jhsg.2025.100789

Hussein Abdul-Rassoul MD, MSc , Jordan Serrote MD , Jeffrey G. Stepan MD, MSc , Jennifer Moriatis Wolf MD, PhD , Jason Strelzow MD, FRCSC

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引用次数: 0

摘要

随着枪支暴力的持续增长，越来越多的手部外科医生被要求处理复杂的手部弹道骨折。然而，关于平民枪击相关掌骨骨折的文献相对缺乏。在本研究中，我们研究了在高容量一级城市创伤中心治疗弹道性掌骨骨折的治疗策略和结果。方法：通过使用到我们一级创伤中心就诊的所有火器相关骨折患者的机构数据库，我们确定了4年内（2019-2023年）所有手部弹道骨折患者。我们回顾了掌骨骨折和相关损伤的图表，以及初次出现时的体格检查特征。我们评估了手术治疗、术后并发症和治疗这些损伤后的结果。结果在4年的时间里，98例患者共发生139例火器相关掌骨骨折。其中，28例39例骨折患者未能随访。其余100例掌骨骨折接受治疗，平均随访5.5个月（范围2-24个月）。其中79例（79%）需要手术干预。36%的病例观察到与这些骨折相关的软组织损伤。在79例手术治疗的骨折中，并发症包括13%的不愈合率，18%的不愈合率和4%的深度感染发生率。总的来说，62%的掌骨手术中最常见的并发症是僵硬。掌指关节的平均活动范围为58。结论：在一个大容量创伤中心治疗的枪击相关掌骨损伤的大型回顾性系列研究显示了这一具有挑战性的损伤的发现和结果。研究结果显示，这些损伤后不愈合的风险中等，僵硬率高，强调了进一步研究的迫切需要，以制定最佳的管理策略，旨在减少火器相关掌骨骨折治疗的并发症。研究类型/证据水平

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Gunshot-Related Metacarpal Fractures: A Retrospective Study and Single Urban Center Experience

Purpose

As gun violence continues to grow, hand surgeons are increasingly called upon to manage complex ballistic hand fractures. However, there is a relative scarcity of literature on civilian gunshot-related metacarpal fractures. In this study, we examine the management strategies and outcomes for ballistic metacarpal fractures at a high-volume, level-1 urban trauma center.

Methods

Through the use of an institutional database of all patients with firearm-related fractures who presented to our level 1 trauma center, we identified all patients with ballistic hand fractures over a 4-year period (2019–2023). Charts were reviewed for metacarpal fractures and associated injuries, and physical examination characteristics at initial presentation. We evaluated the surgical treatments, postoperative complications, and outcomes following the treatment of these injuries.

Results

Over a 4-year period, 98 patients sustained a total of 139 firearm-related metacarpal fractures. Of these, 28 patients with 39 fractures were lost to follow-up. Among the remaining, a total of 100 metacarpal fractures were treated with a mean follow-up of 5.5 months (range, 2–24 months). Of these, 79 (79%) required surgical intervention. Soft tissue injuries associated with these fractures were observed in 36% of cases. Among the 79 surgically treated fractures, complications included a 13% nonunion rate, an 18% malunion rate, and a 4% incidence of deep infections. Overall, the most common complication was stiffness, reported in 62% of operative metacarpals. The average active range of motion at the metacarpophalangeal joint was 58.

Conclusions

This large retrospective series of gunshot-related metacarpal injuries treated at a high-volume trauma center presents findings and outcomes for a challenging injury. The findings showed a moderate risk of nonunion and high rates of stiffness following these injuries, emphasizing the critical need for further research to develop optimal management strategies aimed at reducing complications in the treatment of firearm-related metacarpal fractures.