Abstract
PURPOSE: As gun violence continues to grow, hand surgeons are increasingly called upon to manage complex ballistic hand fractures. However, there is a relative scarcity of literature on civilian gunshot-related metacarpal fractures. In this study, we examine the management strategies and outcomes for ballistic metacarpal fractures at a high-volume, level-1 urban trauma center. METHODS: Through the use of an institutional database of all patients with firearm-related fractures who presented to our level 1 trauma center, we identified all patients with ballistic hand fractures over a 4-year period (2019-2023). Charts were reviewed for metacarpal fractures and associated injuries, and physical examination characteristics at initial presentation. We evaluated the surgical treatments, postoperative complications, and outcomes following the treatment of these injuries. RESULTS: Over a 4-year period, 98 patients sustained a total of 139 firearm-related metacarpal fractures. Of these, 28 patients with 39 fractures were lost to follow-up. Among the remaining, a total of 100 metacarpal fractures were treated with a mean follow-up of 5.5 months (range, 2-24 months). Of these, 79 (79%) required surgical intervention. Soft tissue injuries associated with these fractures were observed in 36% of cases. Among the 79 surgically treated fractures, complications included a 13% nonunion rate, an 18% malunion rate, and a 4% incidence of deep infections. Overall, the most common complication was stiffness, reported in 62% of operative metacarpals. The average active range of motion at the metacarpophalangeal joint was 58. CONCLUSIONS: This large retrospective series of gunshot-related metacarpal injuries treated at a high-volume trauma center presents findings and outcomes for a challenging injury. The findings showed a moderate risk of nonunion and high rates of stiffness following these injuries, emphasizing the critical need for further research to develop optimal management strategies aimed at reducing complications in the treatment of firearm-related metacarpal fractures. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.