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Shot in shoulder area, grazed collar bone, shattered bones. Damage sustained and recovery period ?

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Orthopaedic Surgeon
Practicing since : 2005
Answered : 43 Questions
If a person was shot several times in the shoulder area, shattering the bones , grazing the clavicle, what would be the possible damage, and what would the probability of recovery be? Would there be possible loss of complete use of the arm and hand? The person would be in poor health already due to being a prisoner of war during the Vietnam conflict. He'd be taken aboard a chopper , given morphine, IV fluids, rudimentary treatment until he got to the hospital at the air base. He would have lost a good deal of blood. I'm a writer (I can give the url of my stories if necessary) and my main character had this happen to him when he was in his late 20's early 30's. Would they have fused his shoulder back together with steel rods back then, and would more recent medicine have a better technique to give him less difficulties late in life? I want him to have survived, but down the road, say in his 40's-50's, he continues to have pain in the shoulder and possibly the arm, and handles it with pain killers. This is part of my story, is this description accurate, how would he have been treated? How long would be his P.T. Story excerpt: "You can look at it. My paper cut? Let's see. Eighteen stitches. Each at least an inch wide. Bullet went into my left shoulder, shattered bones, grazed my brachial nerve. They didn't think I'd ever move my arm again let alone fly again.

Thanks, this would help my story be accurate. Any additional info would be appreciated.
Wed, 23 May 2012 in Bones, Muscles and Joints
Answered by Dr. Sangeet 4 hours later

Thanks for posting your query here.

Seems like an exciting war movie script.

If the bullet has grazed his collar bone, it could very likey hit his brachial nerves resulting in paralysis of his affected arm. Multiple bullets would cause also cause bad fracture of his shoulder and humerus which has a questionable prognosis even in this era.

Penicillins were popularized in those times (1945), but I ain't sure if they were used in the Vietnam war. You need to check on that. If not, then the chances of infection will be very high and he might need an amputation of his whole limb from the shoulder to prevent spread of the infection. If the infection were to be controlled, his shoulder would have been fused with plates and screws and the mobility of his shoulder would be grossly restricted and would be associated with pain too.

Multiple bullets around the shoulder can also cause lung damage and cause blood or air filled lung sac which can in turn cause decreased oxygenation and death too if untreated.

Hope I solved your query. I would be available to answer your further queries.

All the best and wish you success.

Above answer was peer-reviewed by
Follow-up: Shot in shoulder area, grazed collar bone, shattered bones. Damage sustained and recovery period ? 4 hours later
Suppose it just grazed the brachial nerve, would the possibility of paralysis of the arm be as high, and I estimate about 20-25 minutes on the medical chopper until he is taken to the hospital and more extensive treatment begins, including massive antibotics to treat the infections he'd have due to being a P.O.W. malaria, things of that kind. I want a scenario that would give him the very best chance to recover fully with at least 80%-90% use of the arm and fingers with extensive physical therapy. Where would the bullets have to hit to ensure that, and with an injury that serious would he be conscious for long, or would he immediately pass out from the pain and injury, would that depend on his will power, or a medical issue. Also, if it did cause blood filled lung sac, how fast would he have to be put on oxygen to keep him stable until they could operate? Since he has to survive on whatever is available in the vietnam era, I don't want a wound so bad that he would die immediately, but I do want an injury that would require the fusing of his shoulder with plates and screws, causing the need for immobility, with perhaps pins in the shoulder permanently holding the bones together. I need names of the bones, what medications, how would you treat that patient with that injury, what is the extent of the pain, how much recovery time, and would he have pain in the future. If he were to have a operation in the future, say ten years ahead, what kind would be done to correct the injury, what are the newer treatments to restore full or almost full mobility. What would be his symptoms in the future, what would the stitching be like, how large would the wound be?
Answered by Dr. Sangeet 3 hours later
Hello again XXXXXXX

Thanks for the reply.

I prefer to answer chronologically.

- Yes, if the bullet just grazed the collar bone, he could possibly get a brachial nerve injury with paralysis, which would resolve in 2-6 weeks time.
- This paralysis would resolve with physiotherapy as its a temporary paralysis. It's called brachial plexus neuropraxia, if you would like to mention it.
- This injury reverts back to almost 100 % normalcy.
- If the injury hits his humerus (arm bone), the fracture would be very painful. The pain would subside with analgesics/ morphine. And cause a wound which can be well controlled with antibiotics.
- If he had an air filled lung sac, which is caused by the bullet, the medics could diagnose it in the chopper and stick a thick needle into his chest to suck out the air.
- He would require oxygen within 10-15min of the injury.
- I think 2-4 bullets or even a single one is sufficient to cause a fracture around his shoulder which would require fusion and not necessarily cause an infection.
- It would cause severe pain and would require around 2 months to recover during which the shoulder would be in a plaster cast extending across his chest and arm. Following shoulder fusion with plates, he would be able to gain 30 % of his shoulder movements due to movements at the joint between the scapula and the rib cage rather than the shoulder itself.
- Names of bones around the shoulder:
Collar bone- clavicle
Arm bone- humerus
shoulder blade- scapula.
- If he had to undergo a surgery after 10 years, that would be shoulder arthroplasty wherein the shoulder joint is replaced by metal and plastic. He would gain some more function after this. However, the success rate of shoulder arthroplasty, over a long term basis is not good. Following fusion, he would never regain full mobility of his shoulder, whatever the surgery or the era may be.
- His symptoms would be restricted movements of the shoulder, especially reaching for overhead objects or may have intermittent pain or swelling.
- The stitching would extend over the contour of his shoulder, approximately 15-18cm with 18-22 stitches.

Hope I have answered your query. I would be available for your follow up queries.

Thank you.
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