橈骨および脛骨の銃撃骨折の治療経験

Gunshot Fracture of the Radius and Tibia. Case Report

　銃規制の厳しい本邦では比較的めずらしい銃撃骨折を経験したので報告する．患者は26歳の男性で，主訴は左前腕部・左下腿部の銃創であった．アフリカで受傷し，開放性粉砕骨折であり，初期治療後に当院搬送となった．左橈骨は短縮転位を残したままプレート固定を受けており，可動域制限・尺骨遠位の背側脱臼を呈していた．左脛骨は約6cmの骨欠損が残存していた．橈骨のプレートは温存し，尺骨遠位端脱臼には尺骨短縮術を施行した．脛骨は，血管柄付き遊離腓骨移植で再建を行った．受傷後3年になるが経過良好である．

　Gunshot fractures are rare in Japan because of strict gun laws. We report a case of a gunshot fracture of the radius and the fibula. A 26-year-old man sustained a gunshot wound of the left forearm and left leg in Africa and was treated at a nearby hospital. He then returned to Japan and was sent to our hospital. Because ofpersistent shortening of the radius, the distal end of ulna had become dislocated, and ulnar-shortening osteotomy was performed. A free vascularized fibula graft was used to treat segmental bone loss of the left tibia. At the 3-year follow-up examination, complete healing was observed, and the patient had returned to normal activity.