Clinical Example: Transmetacarpal gunshot wound immediate reconstruction with iliac crest bone graft

Accidental self inflicted gunshot hand wounds are common, usually involving the nondominant hand. This man accidentally disharged a clean fishing bang stick into the palm of his nondominant hand. He had paresthesias involving the adjacent sides of his middle and ring finger. He was treated with immediate wound debridement and reconstruction of the middle metacarpal with iliac crest bone graft.

This case followed the school of thought that because this was a low energy gunshot type injury, the zone of injury could be defined well enough to proceed with immediate reconstruction - fewest operations, fastest recovery, best chance of best possible final result.

There are many other options, including delayed reconstruction. The fact that he had been spared significant nerve, vascular or tendon disruption made his chances of good result better than average regardless of the management path chosen.

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Entry and exit wounds.