# Humeral shaft reconstruction surgery following military combat gunshot injury using a titanium spinal mesh cage - A case report

## TL;DR

A military soldier with a severe gunshot injury to the upper arm underwent successful reconstruction using a titanium spinal mesh cage, achieving full limb recovery.

## Contribution

First Indian case report of using a titanium spinal mesh cage for humeral shaft reconstruction after a combat-related gunshot injury.

## Key findings

- The titanium spinal mesh cage provided mechanical stability and a scaffold for bone grafting in a large humeral defect.
- The patient achieved full functional recovery of the limb with confirmed fracture union.
- This approach offers an alternative to conventional techniques for complex gunshot-related bone defects.

## Abstract

High-velocity gunshot injuries to the upper extremity are rare but devastating, particularly in military personnel, and are associated with high risks of infection, instability, and limb loss. Reconstruction of extensive segmental bone defects in such cases is a complex surgical challenge.

We report a challenging case of a 32-year-old Indian Air Force soldier who sustained a Grade 3B open right humeral shaft fracture from a gunshot wound during military combat. Initial management included wound debridement, skin grafting, and external fixation at military hospital. Three months later, he presented to our center with a 10 cm segmental bone defect, gross arm instability, and stiffness in shoulder and elbow joint. Definitive humeral reconstruction was carried out using a fibular graft engrafted into a customized spinal cage and stabilization following a fixation with a plate. Long-term follow-up confirmed fracture union and full functional recovery of the limb.

Gunshot injuries pose unique challenges due to bone comminution, soft tissue damage, and instability. Conventional techniques like bone transport or shortening may not provide sufficient anatomical and biomechanical restoration. The spinal mesh cage served as a structural scaffold, reducing the required volume of autograft while ensuring mechanical stability.

Gunshot fractures of the humerus should be approached as a distinct clinical entity. The use of a titanium spinal mesh cage provides anatomical alignment, mechanical stability, and a scaffold for autologous bone grafting, making it a viable option for reconstructing large upper limb defects.

•Military combat injuries demand a multidisciplinary approach for optimal limb salvage.•First Indian case report of humeral shaft reconstruction utilizing a titanium spinal mesh cage.•Military combat-related gunshot wounds often result in severe osseous and soft tissue disruption.•Intramedullary spinal mesh cage provides a stable scaffold for bone regeneration and fixation.

Military combat injuries demand a multidisciplinary approach for optimal limb salvage.

First Indian case report of humeral shaft reconstruction utilizing a titanium spinal mesh cage.

Military combat-related gunshot wounds often result in severe osseous and soft tissue disruption.

Intramedullary spinal mesh cage provides a stable scaffold for bone regeneration and fixation.