Gunshot Wound To The Hand

While earlier gunshot wounds were common during war times, these days, gunshot injuries have become common even in a civilian’s life. Gunshot wounds to hand are also a common presentation at trauma centers and need appropriate treatment depending on the severity of the wound. While most of the high velocity gunshot wounds to the hand may be noticed in military wounds, civilians may be commonly encountered with low velocity weapons.

Although gunshot hand injuries may not always be life-threatening, they are more challenging due to the functional importance of the hands. Earlier, infection due to gunshot wounds to the hand was more of a concern, but with advancement in medical sciences, infection can be well-controlled and the functional abilities of the hand need to be dealt with more carefully.

The anatomy of the hand involves many structures; placed in such a manner that injury to an area can result in varying degrees of damage to the parts. Like in any gunshot wound, the bullet crushes the tissue it first penetrates into and further tissue damage occurs due to temporary cavitation. The impact of tissue damage can be more direct if there is deformation and fragmentation of the bullet.

Injuries to the hand mostly occur when the hand structures are directly hit by an intact bullet, fragments of bullet or secondary missiles. In case of hands, tissues like skeletal muscles are more elastic in nature and hence may be less affected by the cavitation pressure as compared to the tissues of internal organs like liver, spleen or brain.

Hand injuries caused by low-velocity weapons generally result in a wound of a localized nature. In most cases, there are injuries to the bone and soft tissues of the hand. The common hand injuries due to gunshot involve fracture of bones of the hand and small bones of the fingers, bone instability, bone loss, soft tissue injuries to the muscles and related structures, tendon and ligament injury and in some cases damage to the nerve or blood vessels may be noticed. The commonly involved bones of hand include phalanx, interphalangeal joint, carpal bones, metacarpal, metacarpophalangeal joint, radius and ulna.

These injuries need to be identified correctly and appropriate wound management approach should be adopted to reduce the long lasting effects or comprise of functional outcomes.

Gunshot wounds to the hands, often present with some history, which is noted and careful assessment of the patient is done. If the patient’s condition demands emergency care for resuscitation, appropriate measures are taken. Examination of the gunshot hand wound is performed to identify the possible injuries in order to plan immediate treatment. X-rays and other imaging studies may be considered to detect the presence of bone injuries and soft tissue injuries.

Most low velocity weapons lead to localized injuries, which may be managed non-operatively. Most of the wounds require cleansing and are managed with irrigation, debridement and elevation of the injured part of the hand. In cases that require surgical management minimal debridement should be done. Antibiotic treatment may be given to prevent the risk of infections.

Fractures of bones are managed with early fracture stabilization, internal or external fixation, reduction and splinting. The type of treatment and the requirement of surgical intervention, follow-up surgeries and complex treatment methods depend on the extent and severity of the injuries. The functional outcome of the injured part also needs to be considered.

In some cases, bone grafting and amputation of digits or the damaged part may be required. Some patients may require treatment with soft tissue coverage and even revision of fracture fixation. In some cases, additional surgeries like bone grafting and arthrodesis may also be required after the initial treatment.

Infections may result during or after the treatment, which may require appropriate treatment with antibiotics depending on the severity. Most cases may be a result of superficial soft tissue infection, which respond well to antibiotic therapy.

The rate of complications can be reduced by timely treatment, with limited debridement and definitive fixation of fracture performed early during the treatment phase. In order to effectively deal with gunshot wounds to the hand, immediate treatment can help to reduce the rate of infection and other complications that can hinder the recovery process.

In case of extensive injury to the hand, associated additional wounds or other complications, extensive surgical debridement and a staged approach of treatment for reconstruction is required. In these cases, wound management for contamination and soft tissue coverage is primarily focused on, after which definitive fixation and bone grafting is considered.

Appropriate treatment and wound management is essential to regain the structure and function of the injured parts. The chances of recovery can be better with timely action, emergency care and treatment. The primary aim is to maximize functional ability and minimize the limitations or long-term disabilities related to hands, which can be achieved through thoughtful planning and appropriate reconstruction alternatives followed by rehabilitation methods.

Progress also depends on patient’s compliance in case of gunshot wound to hands. Hand injuries to a specified area may not be life threatening, however, when they are coupled with additional injuries to other areas, it may be complicated by delayed recovery.

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