Case: We describe an unusual case of an isolated close-range shotgun injury to the thumb with substantial osseous loss and intact vascularity, followed by treatment with the Masquelet technique and iliac crest tricortical bone autograft reconstruction.
Conclusion: Gunshot injuries to the thumb with concomitant soft-tissue and osseous loss are devastating. Reconstruction depends on the level of the injury, the severity of the soft-tissue and osseous damage, and the viability of the digit, as well as patient factors, including occupation, physical demands, and expectations.