Recent advances in the treatment of gunshot fractures of the humeral shaft.

The increase in violent crime has lead to an increase in gunshot-induced fractures in the United States. Injuries to the upper extremity are common. The treatment of gunshot injuries depends on the extent of soft tissue disruption and the type and location of fracture. Most of these injuries are a result of low-energy gunshot wounds that may be treated conservatively under the appropriate conditions. Low-energy fractures that require operative stabilization may be done with predictable results for achieving union with intramedullary fixation or compression plating. Complex open fractures from gunshot wounds associated with neurovascular injuries present a therapeutic challenge to the orthopaedic surgeon. The fractures associated with these injuries often are comminuted and unstable. Bone loss is common. Soft tissue disruption plays a more important role in high-energy gunshot-induced fractures. In these cases, external fixation is the treatment of choice for stabilization. Recent advances in the use of external fixation have led to quick fracture stabilization, stability for vascular repair, and access to the wound for debridement and subsequent soft tissue surgery.