Outcomes of Complex Gunshot Wounds to the Hand and Wrist A 10-Year Level I Urban Trauma Center Experience

Purpose: To assess the consequences of gunshot wounds (GSWs) to the hand, we reviewed our 10-year experience at an urban level I trauma center. Method: A retrospective review was performed on patients admitted with GSWs to the extremities between January 1, 1997 and January 1, 2007. Those with GSWs to the hand and wrist needing surgery were studied. A telephone survey supplemented the data. Results: Of 1358 patients admitted with GSWs involving the upper extremities, 62 patients with complex hand and wrist injuries requiring operative intervention were identified. Most patients sustained low-velocity handgun injuries and presented within 12 hours of injury. In many individuals (97%), the gunshot injury to the hand or wrist was only part of a multiple gunshot assault. All patients underwent surgical debridement and repair followed by an early aggressive rehabilitation program. Mean length of hospital stay was 5.0 (+/- 5.1) days, with 9.7% of patients requiring ICU care for 3.3 (+/- 1.4) days, with an average cost of $47,819 (+/-$ 53,548) per patient. Although 65% of the individuals subsequently reported being disabled from work due to pain, the quality of life, and ultimate function was good in 61%, fair in 26.1%, and bad in 13%. Conclusion: GSWs to the hand and wrist are often part of multiple handgun wounds in one individual. Most produce comminuted fractures, seldom requiring bone grafts, fusion, or amputation. Vascular injuries, though rare, necessitate vein grafts due to loss of length. Few patients require free flaps, and few sustain nerve or tendon injuries. Most complain of pain or numbness. However, a good quality of life and a return to the activities of daily living occurred in two-third individuals.