Outpatient Treatment Guidelines of Gunshot Wound to the Hand and Wrist Resulting in an Open Fracture: Case Report.

The incidence of non-fatal gunshot wounds has significantly increased in the past decade. The current guidelines lack clarity in treatment of bullet wounds to the hand and wrist. An 18-year-old male presented to the emergency department with a gunshot wound to the hand/wrist resulting in an open fracture. The entrance wound was clean without visible bone. No neurovascular damage was reported. The wound was irrigated with saline, and a sterile dressing and splint was applied in the emergency department. The patient was discharged the same day with oral antibiotics and an appointment with an orthopedic hand specialist. Three days after the injury, the patient was taken to surgery to treat a fracture of the radius and lunate. No internal fixation was required. The fracture and bullet fragments were removed, and the patient was discharged on the same day. The patient recovered to a full range of motion and no infection was acquired throughout treatment and healing.  The current guidelines for the treatment and management of nonfatal gunshot wounds to the hand and wrist are inconsistent resulting in unnecessary admittance to the hospital. Our paper provides a template for future cases allowing for outpatient treatment.