Case Presentation: A 54-year-old male with no significant past medical history presented with a self-sustained gunshot wound (GSW) to the non-dominant hand that occurred while cleaning his handgun. On exam, the flexor tendons and digital nerves were intact with slight neuropraxia of the ulnar digital nerve. Patient works as a security guard and is unable to perform his job with activity restrictions. The patient’s objective was to return to full activities as soon as possible. When discussing options, the patient requested to minimize recovery time and was reluctant to proceed with any technique which would likely require a second trip to the operating room (OR).
X-rays revealed a highly comminuted fracture of the third metacarpal. Due to concerns about additional shortening, compression screw or K-wire fixation were eliminated as options. Plates and screws were considered, but would need to be applied very distally on the metacarpal head in order to achieve stable fixation. A plate and screw approach would likely result in a need for future procedures, including capsulotomy of the metacarpophalangeal joint and extensor tenolysis.