title: [Severe hand injury due to a high-energy gunshot projectile treated with arthrodesis of the carpus, synthetic bone graft and external fixators. Case report].
abstract: BACKGROUND
  The incidence of hand gunshot wounds in civil patients has increased in recent years; it causes long-term or permanent disability and has a personal, social and economic impact. Severe hand injuries include: involvement of the greater palmar arch, fracture of two or more carpal bones, irreducible palmar dislocations, articular fractures of the distal radius, and neurovascular injuries. All of these injuries require multiple surgical procedures for the management of soft and musculoskeletal tissues.
  
  
  METHODS
  We report the case of a patient with a Gustilo and Anderson grade IIIB open fracture of the right carpal bones caused by a gunshot projectile. He was treated with arthrodesis of the carpus using a synthetic graft, external fixation and rotation of a fasciocutaneous flap.
  
  
  RESULTS
  The patient underwent surgical treatment of the carpal injury that consisted of Gustilo and Anderson grade IIIB open fracture of all carpal bones caused by a gunshot projectile. Surgery included arthrodesis of the carpus with a synthetic graft, stabilization with an external fixator, and a fasciocutaneous graft as skin cover. The clinical course according to the DASH scale had a score of 14.2 and the Michigan Hand score was 70, with a 12-month follow-up.
  
  
  CONCLUSIONS
  Treatment with external fixation plus arthrodesis of the carpus with a synthetic graft and skin cover using a flap provided a good functional result in a patient who sustained a gunshot wound.
authors.forename: D
authors.initials: D
authors.lastname: De la Rosa-Massieu
authors.forename: M
authors.initials: M
authors.lastname: González-Sánchez
authors.forename: W
authors.initials: W
authors.lastname: Onishi-Sadud
authors.forename: J
authors.initials: J
authors.lastname: Gómez-Chavarría
authors.forename: A
authors.initials: A
authors.lastname: Bello-Gonziláz
mesh_terms: D000293:Adolescent; D001174:Arthrodesis; D050824:Carpal Joints / Q000601:surgery*; D003131:Combined Modality Therapy; D016267:External Fixators; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D019736:Prostheses and Implants; D014948:Wounds, Gunshot / Q000601:surgery*