Case Study: Use of INnate Intramedullary Threaded Nail for K-wire Revision in a Two-Metacarpal Gunshot Wound Injury – David Wilson, MD

Case Presentation:
Patient was a 30-year-old right-hand dominant male military police officer who suffered a self-inflicted gunshot wound to his left hand. He was initially treated with incision and drainage (I&D) and closed reduction percutaneous pinning (CRPP). The K-wires were removed as planned at six weeks. Range-of-motion progression was delayed due to pins and then due to persistent radiographic lucency and persistent tenderness on exam. Pending nonunion with a bony defect was diagnosed at eight weeks and revision surgery planned. The gunshot wound caused oblique, base fractures with comminution to the third and fourth metacarpals. Revision was required at 10 weeks with iliac crest bone graft augmentation due to the nonunion with bony defect following K-wire fixation. The nonunion with deficit led to the recommendation of utilizing an intramedullary (IM) approach with an implant that provided more rigidity and cortical fixation for stabilization.