case_images: PMC11794452_01
case_images: (A) Preoperative X-ray showing the bullet lodgment along the volar aspect of the distal radius. (B) Preoperative X-ray showing the external fixation device with pins at the proximal and distal ends of the right humerus with shattered mid-third of the shaft, surrounded by displaced fracture fragments, which was shattered along the bullet's tract before settling in the wrist.
case_images: rjaf036f1.jpg
case_images: PMC11794452_01_rjaf036f1.jpg
case_images: f1
case_images: Right upper limb X-rays revealed external fixation device with pins at the proximal and distal ends of the right humerus with shattered mid-third of the shaft, surrounded by displaced fracture fragments, crushed proximal radius fracture with intramedullary nailing noted in satisfactory position, and a 5 x 1 cm bullet was seen lying longitudinally along the volar aspect of the distal radius (Fig. 1A and B).
case_images: Intraoperative X-ray showing severe adhesions of the radial, median and ulnar nerves in the proximal 2/3rd of the arm, adhesions were lesser as the nerves coursed distally in the lower arm and proximal forearm.
case_images: rjaf036f2.jpg
case_images: PMC11794452_01_rjaf036f2.jpg
case_images: f2
case_images: The radial nerve was completely severed with a marked gap between the distal and proximal ends (Fig. 2).
case_images: Intraoperative X-ray showing the final position of the bullet on the volar aspect of the radius.
case_images: rjaf036f3.jpg
case_images: PMC11794452_01_rjaf036f3.jpg
case_images: f3
case_images: Complete decompression of the peripheral nerves in addition to bullet extraction was performed by Plastic Surgery, with a plan for tendon transfer in regard to the severed radial nerve later on. (Figs 3 and 4) During the surgery, the brachial artery was found severely attenuated, matted to the venae comitantes, and stuck to the bone at fracture site without any recognizable plane in-between, and during adhesiolysis, the artery was inadvertently injured.
case_images: The bullet post extraction with a length of 5 centimeters.
case_images: rjaf036f4.jpg
case_images: PMC11794452_01_rjaf036f4.jpg
case_images: f4
case_images: Complete decompression of the peripheral nerves in addition to bullet extraction was performed by Plastic Surgery, with a plan for tendon transfer in regard to the severed radial nerve later on. (Figs 3 and 4) During the surgery, the brachial artery was found severely attenuated, matted to the venae comitantes, and stuck to the bone at fracture site without any recognizable plane in-between, and during adhesiolysis, the artery was inadvertently injured.