Gunshot injury to the upper limb with an unusual bullet trajectory

Abstract

Gunshot injuries are not common in European Union countries, although the trend is observed to increase their number over the years [1]. Firearm injuries to the upper extremity are very uncommon. The results of a Swedish study from an urban major trauma center showed only 3 cases of this injury location in a 73 total gunshot wounds treated in one year; the lower extremity was the most commonly involved [1]. If they occur, they are usually the result of accidental shots from hunting rifles, less commonly from police guns or as a result of criminal encounters. As the size of the upper extremity is not great (compared to, e. g. the trunk), the vast majority of these wounds are penetrative by character, with clearly visible entry and exit parts. The spectrum of tissue damage is usually complex, including bone fractures, vessel, nerve, tendon and muscle injuries. Treatment of gunshot wounds may be challenging, particularly if they require reconstruction of several structures [2], [3], [4]. Sometimes complex repairs may be not possible due to tissue defects and the risk of infection. We report the case of a gunshot wound involving the right forearm, arm and shoulder, running along the axis of the upper limb. The entry wound was located in the middle forearm, the trajectory ran along the whole arm and ended at the right clavicle, very close to the axillary artery, where the bullet was found. In spite of such a long distance travelled, the bullet wounded only the brachial artery in the cubital fossa.