Ballistic Distal Radius Fractures: A Single-Center Experience in Management and Outcomes

Purpose: Gunshot wounds (GSWs) to the upper extremities can be devastating and often require surgical treatment. Ballistic injuries to the distal radius in particular present a complex challenge for hand surgeons because of concerns of bony comminution, neurovascular injury, and injury to surrounding structures. This study compares the demographics, management, and complications of nonballistic versus ballistic distal radius fractures (DRFs). Methods: In this retrospective study, patients over the age of 16 years with radiographically confirmed DRFs were reviewed from 2018 to 2023. Demographic data, surgical details, and postoperative complication data were collected. X-ray imaging was evaluated for fracture healing. In addition to comparison of all patients, 1:1 matched cohort comparison was conducted, controlling for age, smoking, and fracture classification. Results: Of the 265 patients, 21 had DRFs due to GSWs, and 244 sustained DRFs from other mechanisms. GSW patients were significantly younger and predominantly male. Arbeitsgemeinschaft für Osteosynthesefragen classification demonstrated higher intra- and extra-articular comminution in GSW patients, and GSW patients had higher rates of distal radioulnar joint instability and carpal fractures. Additional injuries outside the upper extremity and neurovascular symptoms were also more common in GSW patients. GSW patients were more likely to undergo surgery and had longer times to surgery. Despite the delayed surgical intervention, no differences were observed in fixation methods, time to full weight bearing, or complications between groups. After 1:1 matching, there remained a significantly higher proportion of men in the GSW cohort, a higher rate of carpal fractures, a higher rate of nonhand injuries, and a greater time to surgery in the GSW cohort. There remained no significant difference in complications. Conclusions: Because of their complexity, GSWs to the upper extremities present considerable management issues. The present study compares ballistic to nonballistic injuries to the distal radius. Although there were differences in presentation and surgical management, there were no significant differences in complications. Type of study/level of evidence: Prognostic IV.