Abstract
Background: Firearm-associated injuries in the U.S. represent a major public health crisis, contributing substantially to major levels of morbidity, mortality, and economic stress. Recommendations for the management of gunshot-related hand fractures remain limited, particularly in low-velocity injuries, and current guidance often leaves treatment decisions to the discretion of the operating surgeon. Methods: A retrospective analysis was performed to identify phalangeal and metacarpal fractures at a Level I trauma center from 2017 to 2023, resulting in 579 patients. Only fractures resulting from firearm injuries were included, resulting in 56 patients. Infection rates were observed in patients treated nonoperatively and those treated operatively. Results: Of the 56 patients, 38 (68%) were treated operatively, and 18 (32%) were treated nonoperatively. The overall infection rate was 2 of 56 patients (3%). Two of the 38 patients treated operatively developed an infection after surgery (5.26%). Of the two patients who developed an infection, one required a return visit to the operating room. Both patients who developed infections reported current tobacco use, and one also had a history of poorly controlled diabetes. All patients in the study received antibiotics at presentation, most commonly 2 g of cefazolin or ceftriaxone. Conclusion: Guidelines for the management of low-velocity, gunshot-related hand fractures remain debated, particularly regarding the need for debridement and prophylactic antibiotic administration. This study suggests that low-velocity fractures of the phalanges and metacarpals that do not warrant bony or soft-tissue procedures may be managed without antibiotics and formal irrigation and debridement, without an associated increase in infection risk.
Recommended Citation
Summers, T. Kyle; Ian Garrison; Matthew C. Watterson; Brandon Barnes; and Charles Rodriguez-Feo. "Infection Rates in Gunshot-Related Hand Fractures Treated Nonoperatively." Western Journal of Orthopaedics 15, 1 (2026). https://digitalrepository.unm.edu/wjo/vol15/iss1/7