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Gunshot-Related Metacarpal Fractures: A Retrospective Study and Single Urban Center Experience
Hussein Abdul-Rassoul1, Jordan Serrote2, Jeffrey G Stepan2
1Department of Orthopaedics, Washington University in St. Louis, St. Louis, MO.
Journal of Hand Surgery Global Online
|August 20, 2025
Summary
Gunshot-related metacarpal fractures are common in urban trauma centers. Management involves surgery for most, with high rates of stiffness and moderate risks of nonunion and malunion.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Ballistic Trauma
Background:
- Gun violence is increasing, leading to more complex hand injuries.
- Ballistic metacarpal fractures require specialized management by hand surgeons.
- Limited literature exists on civilian gunshot-related metacarpal fractures.
Purpose of the Study:
- To examine management strategies and outcomes for ballistic metacarpal fractures.
- To analyze data from a high-volume, level-1 urban trauma center.
- To address the scarcity of literature on civilian gunshot injuries to the metacarpals.
Main Methods:
- Retrospective review of a level-1 trauma center's institutional database (2019-2023).
- Identification of patients with firearm-related metacarpal fractures.
- Evaluation of surgical treatments, complications, and outcomes.
Main Results:
- 100 metacarpal fractures in 70 patients were treated over 4 years.
- 79% of fractures required surgical intervention.
- Complications included 13% nonunion, 18% malunion, and 62% stiffness.
Conclusions:
- Gunshot-related metacarpal injuries present a significant management challenge.
- These injuries carry a moderate risk of nonunion and a high rate of stiffness.
- Further research is needed to optimize treatment strategies and reduce complications.
