Fibular Allograft Osteoplasty and Silicone Arthroplasty following Gunshot Injury of the Metacarpal.

The complexity of a gunshot wound to the hand with segmental bone loss and adjacent joint disruption presents a unique challenge for the reconstructive surgeon. There are several options for posttraumatic reconstruction of hand joint defects, ranging from arthrodesis, implants, and autologous arthroplasty. Despite the abundance of literature regarding guidelines for isolated osteoplasty and arthroplasty, there are only case reports describing management of bone and joint defects, all within the setting of cancer resection. This case report presents a 24-year-old, right-hand dominant man with a gunshot wound to his left hand involving the fifth metacarpal and metacarpal phalangeal joint. The metacarpal was reconstructed with a fibular bone allograft with simultaneous placement of a silicone arthroplasty implant, allowing preservation of motion at the metacarpal phalangeal joint with satisfactory functional outcomes. This illustrates the feasibility of successfully reconstructing segmental bone loss and adjacent joint defects simultaneously in the traumatic setting of firearm injuries.