title: Shotgun injury to the arm: a staged protocol for upper limb salvage.
abstract: Low-energy shotgun fractures involving the arm are complex injuries. Previously published reports have emphasized various problems associated with these injuries. This case report describes a low-energy shotgun wound managed by a staged treatment protocol involving: (1) a spanning external fixator and immediate soft tissue management, followed by (2) osteosynthesis and autogenous bone grafting and (3) epineural suturing of injured radial nerve, with a successful outcome. Although adequate debridement of the fracture and soft tissue wound is the key to open fracture management, some difference of opinion exists with regard to the timing of bone reconstruction and grafting. In severe type III open fractures, or in wounds that are marginal, it may be best to delay cancellous bone grafting until soft tissue has stabilized following acute trauma when the risk of infection has been minimized. If early coverage of vital structures is not possible, local or remote flap coverage may be necessary.
authors.affiliation: University Clinic for Traumatology, Medical School, University of Zagreb, Draskoviceva 19, 10000 Zagreb, Croatia.
authors.forename: Darabos
authors.initials: D
authors.lastname: Nikica
authors.forename: Cesarec
authors.initials: C
authors.lastname: Marijan
authors.forename: Grgurovic
authors.initials: G
authors.lastname: Denis
authors.forename: Rutic
authors.initials: R
authors.lastname: Zeljko
authors.forename: Darabos
authors.initials: D
authors.lastname: Anela
authors.forename: Kenneth
authors.initials: K
authors.lastname: Egol
mesh_terms: D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D011859:Radiography; D016879:Salvage Therapy / Q000379:methods*; D015599:Trauma Severity Indices; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging / Q000601:surgery*