Clinical and radiological outcomes of callus preservation versus excision in gunshot-related distal humerus fractures.

BACKGROUND

High-energy gunshot injuries to the distal humerus frequently result in extensive comminution, severe soft-tissue damage, and contamination, making definitive fixation both technically demanding and biologically challenging. During staged management with temporary stabilization, extra-articular callus formation may occur prior to definitive fixation, potentially influencing the surgical decision to preserve or excise this tissue. This study aimed to evaluate the clinical and radiological outcomes of a fixation strategy that preserves extra-articular callus in high-energy distal humerus fractures caused by gunshot injuries.

METHODS

This retrospective study included 21 male patients with Gustilo-Anderson type IIIA distal humerus fractures caused by high-velocity gunshot injuries, treated between 2016 and 2024. All patients initially underwent temporary stabilization followed by definitive fixation. Patients were stratified according to whether the extra-articular callus tissue was preserved (n=9) or excised (n=12) during surgery. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Mayo Elbow Performance Index (MEPI), and radiographic union time was recorded.

RESULTS

The mean patient age was 28 years (range, 22-43). According to the AO/OTA (Arbeitsgemeinschaft für Osteosynthe-sefragen/Orthopaedic Trauma Association) classification system, 81% of fractures were type 13C3. Nerve injury was present in five patients (23.8%), and heterotopic ossification developed in five patients (23.8%). No significant intergroup differences were observed in DASH scores, MEPI scores, range of motion, or infection rates (all p>0.05). However, union time was significantly shorter in the callus-preserved group compared with the excision group (18.0±3.1 vs. 23.5±3.3 weeks, p=0.004). Nerve injury (p=0.043) and heterotopic ossification (p=0.025) were associated with higher DASH scores, indicating poorer functional outcomes.

CONCLUSION

A callus-preserving fixation approach may offer a biological advantage in the management of high-energy distal humerus gunshot fractures by promoting earlier bone healing without compromising functional outcomes. When extra-articular callus does not interfere with anatomical reduction, preserving it in situ may be considered as part of a staged damage-control-to-definitive fixation strategy.