Clin Should Elbow.  2012 Jun;15(1):37-42.

Treatment of Open Proximal Humerus Fracture by Gunshot

• Kim SJ
• Lee JH
• Chun YM

Abstract

PURPOSE
To consider the proper managment of proximal humerus fracture on gunshot wounds.
MATERIALS AND METHODS
A 28-year-old male patient, who sustained a gunshot injury on the left arm 5 days ago, was admitted through the emergency department. Although he underwent an emergency surgery (bullet fragment removal and debridement), there remained bullet fragments around the proximal humerus fracture site. The wound seemed to be infected and a partial dehiscence occurred. No neurologic deficit was noted. Immediate exploration and debridement were performed, and an external fixator was applied to restore the anatomical alignment and manage the wounds. Intravenous antibiotics were administered. On the 9th postoperative day, wound debridement was done again, and cement beads mixed with antibiotics were inserted. After two weeks, the external fixator was removed, and the pin sites were closed after debridement. One week later, the open reduction and internal fixation with locking compression plate and screws were done.
RESULTS
At 3 months after the internal fixation, the bone union was obtained with satisfactory alignment of the humerus.
CONCLUSION
The severity of the soft tissue injury influences the fracture management plan. Further, the risk on lead toxicity should be considered.

MeSH Terms

Adult
Anti-Bacterial Agents
Arm
Debridement
Emergencies
External Fixators
Humans
Humerus
Male
Neurologic Manifestations
Soft Tissue Injuries
Anti-Bacterial Agents