LATE RECONSTRUCTION OF NEGLECTED METACARPAL SHAFT DEFECTS DUE TO GUNSHOT WOUND

Abstract

Introduction: To present the treatment results of a neglected defective metacarpal shaft fracture connected with firearm wounds.
Patients and methods: Between 1996 and 2001, 8 patients with 9 previously afflicted defective metacarpal shaft fractures due to firearm wounds were treated. All of the patients were men and their average age was 22. One lesion was in the second metacarpus, other seven were in the third and the other one was in the fourth metacarpus. Average length of the metacarpal defect was 3,2 cm. and the average time between the gunshot injury and the reconstruction surgery was 10 months. Although all of the patients were treated by the wound irrigation and the debridement at the admitted hospitals, there were no attempts to repair the metacarpal defect and to maintain the metacarpal length and as a result, serious shortenings occurred in the length of metacarpals.
Results: The average follow–up time was 14,75 months. In an average of 12 weeks, a clinical and radiological union was established in all of the grafts’ proximal and distal ends. After the surgical intervention, in the postoperative period, the mean grip strength the hand and the mean range of motion of MP joint are increased as much as %24,3 and %50 respectively.
Discussion: As is in our series, patients with neglected defective metacarpal shaft fractures who are not treated in time via classical methods which advised by Peimer or by the methods of Freeland and his friends, will have a serious metacarpal shortening in the future. We concluded that distraction of all the related tissues first and grafting the defect in the metacarps later is the appropriate late treatment of neglected defective metacarpal shaft fractures.