The patient is a forty year old male liquor store manager who was shot during a robbery with a hand gun. He presented complaining of severe left forearm pain. The patient was right hand dominant and had no other significant past medical history. Physical examination revealed a small dorsal entry wound and a 2 cm volar exit wound. The radial and ulnar pulses were intact and equal to the contralateral side. There were dysasthesias present in the distribution of the median, radial, and ulnar nerves. A compartment syndrome was not present. Motor function was intact in the corresponding distributions. Radiographs (Figure 1) were obtained. A comminuted radial shaft fracture with segmental bone loss was identified. The projectile tract was visualized as well.
The patient was taken to the operating room were a Henry approach was made to the mid portion of the radius. The bullet tract was debrided. Avascular bone fragments were removed and the fracture was irrigated with nine liters of saline. The radius was biologically plated (Figure 2) to maintain length (internal external fixator). The patient was returned to the operating room at forty-eight hours for a second irrigation and debridement.
The patient has a segmental bone loss in the mid-portion of the radius after a gunshot fracture.