Low-caliber gunshot wounds in the hand a report of three cases.

Introduction: Low-caliber gunshot wounds (GSW) to the hand are common and their incidence is increasing. Most low-caliber GSW's are treated in the emergency department (ED) with washout, intravenous antibiotics and any further follow-up treatment usually performed in an outpatient capacity. Treatment of these injuries specifically to the hand may be controversial in terms of timing and extent of washout, debridement, and fixation. Currently, the literature lacks a concise treatment algorithm, and this report aims to provide clinical scenarios that may educate management decision-making for patients with these injuries. Methods: We discuss three cases that failed this initial treatment presenting as an infected nonunion. Each patient underwent irrigation, stabilization, and received antibiotics, yet showed no evidence of interval healing at follow-up. One of the patients demonstrated evidence of infection only one week following the injury. Results: Cultures were positive in all cases and a surgery for debridement, fixation as well as antibiotic treatment was necessary. Only one patient followed up as recommended by the treating surgeon, yet two of three of the patients demonstrated clinical improvement after surgical intervention. Conclusions: Despite being low caliber, this type of GSW to the hand likely causes more damage than to a larger part of the upper or lower extremity given the proximity of vital anatomic structures in the hand. We suggest considering a more aggressive initial treatment in the emergency room, especially for fracture patterns that could otherwise be treated non-operatively and in a particularly nonadherent population.