A case in which a bone fragment caused by a bullet made a second channel in addition to the bullet channel

Bessho, Marie; Unuma, Kana; Nara, Akina; Uemura, Kenichiro

doi:10.1016/j.legalmed.2012.02.006

Cited by 3 publications

(3 citation statements)

References 8 publications

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“…The physical examination and radiological tests facilitated this. Bone fragments themselves set off extra missiles which can have an entirely different pathway [7]. Her nerve and bone injuries were a direct effect of the bullet at entry.…”

Section: Discussionmentioning

confidence: 99%

“…The extent of tissue damage depends on: internal lacerations, compression of tissues and the temporary cavitation along the projectile path [6]. Secondary injuries are also possible following impact with bone, which sets other missiles (bone fragments) into motion on their own paths, causing injury independent of the primary insulting missile [7]. …”

Section: Introductionmentioning

confidence: 99%

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Atypical gunshot injury to the right side of the face with the bullet lodged in the carotid sheath: a case report

2014

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IntroductionGunshot injuries of the head and neck from the AK-47 rifle (a common assault rifle, submachine gun type) are a significant contributor to morbidity and mortality among civilians in Sub-Saharan Africa. They may cause significant damage to the closely arranged structures in this region, and the bullet’s trajectory can be very difficult to determine. We present an unusual case of gunshot injury with an atypical bullet entry wound, profound injury to the face, lodgment in the right carotid sheath, and 'wandering’; a first of its kind in East Africa.Case presentationA 27-year-old African-Ugandan woman of Nilotic ethnicity was referred to the Accident and Emergency Department of a tertiary hospital in Uganda, having sustained complex injuries due to an inadvertent AK-47 rifle gunshot injury. The gunshot injury was to the right side of her face with a large ragged entry wound and no exit wound. Prior basic wound care and radiological imaging showed a comminuted fracture of her mandible with lodgment of the bullet in her neck, anterior to her sixth and seventh cervical vertebrae. Standard debridement of her wound was done. A computed tomography scan showed an apparent cephalad shift ('wandering’) of the bullet, leaving it lying partially anterior to her fifth cervical vertebra as well as within her carotid sheath. Other injuries were to her facial and trigeminal nerves, and her middle ear. The 'wandering’ bullet was successfully removed surgically. It had caused no damage to any part of her neck structure.ConclusionAK-47 rifle bullet injuries may present with uncharacteristically large entry wounds and cause complex structural injuries at the area of impact. The consequent trajectory is difficult to predict making regional examination and radiological investigations essential in management. Bullets may be retained, leaving no exit wound. Securing the airway, controlling hemorrhage and identifying other injuries are the first vital steps. This case illustrates all these interventions and the important decision to extract the entrapped bullet from the patient’s neck because it had started to 'wander’ and could have caused grave injury over time with further migration. Maxillofacial, plastic, trauma, general and military surgeons, otorhinolaryngologists and emergency physicians can gain from this experience because it calls for a multidisciplinary team approach.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Atypical gunshot injury to the right side of the face with the bullet lodged in the carotid sheath: a case report

2014

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“…The most concentrated rib damage was between the 2nd and 6th ribs on the left‐hand side. Impacting a rib would have resulted in some bullet deviation through tissue, and the potential for additional wounding from bone fragments that become secondary missiles .…”

Section: Discussionmentioning

confidence: 99%

An Analysis of the Characteristics of Thoracic and Abdominal Injuries Due to Gunshot Homicides in Israel

Maiden

Hiss

Gips

et al. 2015

Journal of Forensic Sciences

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De-identified wound data from 197 homicidal gunshot postmortems were obtained between 2000 and 2008. Forensic ballistics data were only available for cases between 2004 and 2008. Males represent 91% of gunshot victims and were struck in the thorax/abdomen with an average of 2.3 bullets. The type of firearms involved were semi-automatic pistols in the predominant caliber 9-mm Luger and assault rifles in caliber 5.56 × 45 mm and caliber 7.62 × 39 mm Soviet, using full metal jacket bullets. The majority of shootings occurred at ranges of 1 m or greater. The most common bullet path was front to back in 66% of cases. Entry wounds occurred more often on the left side of the thorax, abdomen, and back. The most common critical organs/tissues to sustain bullet trauma in descending order were as follows: heart, lungs, liver, aorta, spleen, kidneys, and vena cava. Ribs were struck by most bullets that entered the thorax.

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“Bone-shot fracture” – An unusual iliac wing fracture caused by a projectile of autologous bone fragment. A case report

Vieira

Costa

Negrão

et al. 2021

Trauma Case Reports

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Case A young adult male sustained a high-energy crash suffering multiple injuries including a comminuted right femoral shaft fracture and an ipsilateral iliac wing fracture. The iliac fracture was caused by a femoral fragment which was projected and pierced the iliac wing. The patient underwent surgery with retrieval of the femoral fragment and fixation of the iliac and femoral fractures. The lesions healed uneventfully. Conclusion This is the first reported case of an iliac fracture caused by a projectile of autologous bone. High-energy trauma may present unusual or never seen injury patterns to the trauma surgeon.

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A case in which a bone fragment caused by a bullet made a second channel in addition to the bullet channel

Cited by 3 publications

References 8 publications

Atypical gunshot injury to the right side of the face with the bullet lodged in the carotid sheath: a case report

Atypical gunshot injury to the right side of the face with the bullet lodged in the carotid sheath: a case report

An Analysis of the Characteristics of Thoracic and Abdominal Injuries Due to Gunshot Homicides in Israel

“Bone-shot fracture” – An unusual iliac wing fracture caused by a projectile of autologous bone fragment. A case report

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