title: Shoulder fusion after a self-inflicted gunshot wound: an injury pattern and treatment option.
abstract: Gunshot injuries to the shoulder are rare and difficult to manage. We present a case series of seven patients who sustained a severe shoulder injury to the non-dominant side as a result of a self-inflicted gunshot wound. We describe the injury as 'suicide shoulder' caused by upward and outward movement of the gun barrel as the trigger is pulled. All patients were male, with a mean age of 32 years (21 to 48). All were treated at the time of injury with initial repeated debridement, and within four weeks either by hemiarthroplasty (four patients) or arthrodesis (three patients). The hemiarthroplasty failed in one patient after 20 years due to infection and an arthrodesis was attempted, which also failed due to infection. Overall follow-up was for a mean of 26 months (12 to 44). All four hemiarthroplasty implants were removed with no feasible reconstruction ultimately possible, resulting in a poor functional outcome and no return to work. In contrast, all three primary arthrodeses eventually united, with two patients requiring revision plating and grafting. These patients returned to work with a good functional outcome. We recommend arthrodesis rather than replacement as the treatment of choice for this challenging injury.
authors.affiliation: Loyola University Chicago, 2160 South First Avenue, Maywood, Illinois 60153, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Zsoldos
authors.forename: C J
authors.initials: CJ
authors.lastname: Basamania
authors.forename: G K
authors.initials: GK
authors.lastname: Bal
mesh_terms: D000328:Adult; D001174:Arthrodesis / Q000379:methods*; D019643:Arthroplasty, Replacement / Q000379:methods*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012784:Shoulder Fractures / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery; D015599:Trauma Severity Indices; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
keywords: Complex wound management; Gunshot wound; Hemiarthroplasty; Proximal humerus; Shoulder fusion; Shoulder trauma