Interosseous impasse: a unique case of bullet lodgement between the radius and ulna.

Abstract

Gunshot injuries to the upper limb are complex, particularly when a projectile lodges between the radius and ulna. These cases demand a detailed approach due to the complicated anatomy and potential for severe functional impairment. A 42-year-old female presented with severe right upper limb pain and motor impairment following a gunshot injury. The bullet entered through the posterior shoulder, shattered the mid-humerus and proximal radius, and lodged between the distal radius and ulna. Multidisciplinary surgical intervention included external fixator application and removal, open reduction, and internal fixation of the humerus, complete nerve decompression, and vascular repair using an interposition reversed saphenous vein graft. The patient's postoperative course was uneventful, and follow-up showed sensory improvement and some motor recovery. This case highlights the complexity of managing gunshot injuries with bullets lodged between the radius and ulna. Multidisciplinary care is essential for addressing the varied challenges posed by such injuries. Further research is needed to refine treatment strategies and improve patient outcomes in similar cases.