[Gunshot or blast injuries of the hand. Principles of treatment].

Gunshot injuries to the hand are rare in Central Europe. As a result of their special trauma morphology they are a serious threat to the functional integrity of the hand and often lead to a loss of function which can be associated with a permanent unfitness to work or disability. Blast injuries to the hand are more common in this part of the world and are usually caused by the inappropriate use of fireworks. This trauma entity is associated with a number of special kinetic features and effects which have therapeutic consequences and should therefore be discussed separately. As a result of the low incidence of these specific types of injuries in times of peace, experience-based expertise is unlikely to be available. The management of gunshot injuries to the hand is a particular challenge to hand surgeons who must have specialist knowledge and skills in order to achieve an optimum outcome. This applies even more so to the treatment of blast injuries to the hand which are associated with far more complex injury patterns. As a rule blast injuries are associated with a high risk of complications and require a rapid assessment and rigorous management of all damaged structures similar to approaches used for infections of the hand. Illustrated by several cases which have been treated at our institution the basic aspects of the development and morphology of these injuries are discussed as well as different treatment options, algorithms and possible treatment outcomes.