Gunshot fractures of the humeral shaft treated with external fixation

In a prospective study, we assessed 38 consecutive gunshot fractures of the humeral shaft treated between 1 April 1990 and 30 June 1994. The average age was 34 (range, 16-60) years. Average follow-up was 31 (range, 8-50) months. Low-velocity fractures occurred in 35 patients. All fractures were comminuted and displaced. Nerve injuries (radial and/or median) occurred in eight and vascular injuries in three patients. All three vascular injuries had combined nerve injuries. The arteries and nerves were explored; only one artery was found severed and required repair; two arteries and all explored nerves were in continuity. All patients had minimal debridement, antibiotic therapy and stabilization of the fracture with an external fixator. The wounds healed by granulation in 27 patients; seven had secondary closure, and four had split skin grafts. The external fixator was left in place for 6-24 (average, 16) weeks. In 34 patients union occurred between 12 and 24 (average, 16) weeks. Two patients with delayed union required bone grafting. Nonunion occurred in two patients (5%). Full recovery of the nerve palsy without further intervention was observed in seven of the eight cases. Superficial pin track infection was present in five patients; two had deep wound sepsis, and one had bone sepsis. We recommend this treatment for low-velocity humeral shaft fractures.