Ballistics for neurosurgeons: Effects of firearms of customized cranioplasty implants

Abstract

Introduction:There are about 33,000 deaths caused by gunshot wounds in the USA each year. Probably half of these deaths result from head wounds. Among US Army soldiers, 17% of all ballistic injuries are head wounds. This means that, even in those protected by ballistic helmets, gunshot injuries to the head represent a danger. The aim of this study was to examine the effects of shelling of computer-aided designed (CAD) cranioplasty implants made of two different materials.Methods:An experimental model was developed in an indoor gun range. CAD cranioplasties with a material thickness of 2-6 mm, made of titanium or PEEK-OPTIMA® were fixed in a watermelon and shot at with a .222 Remington rifle at a distance of 30 m distance, a .30-06 Springfield rifle at a distance of 30 m, a Luger 9 mm pistol at a distance of 8 m, or a .375 Magnum revolver at a distance of 8 m. The CAD cranioplasties were subsequently inspected for ballistic effects by a neurosurgeon.Results:Titanium CAD cranioplasty implants resisted shots from the 9 mm Luger pistol and were penetrated by both the .222 Remington and the .30-06 Springfield rifle. Shooting with the .357 Magnum revolver resulted in the titanium implant bursting. PEEK-OPTIMA® implants did not resist bullets shot from any weapon. The implants burst on shooting with the 9 mm Luger pistol, the .222 Remington, the .30-06 Springfield rifle, and the .357 Magnum revolver.Conclusions:Titanium CAD cranioplasty implants may offer protection from ballistic injuries caused by small caliber weapons fired at short distances. This could provide a life-saving advantage in civilian as well as military combat situations.

The history of military cranioplasty

“…31 Few studies have investigated this specific question. Lemcke et al 18 evaluated the effect of gunshots on different materials and thicknesses of cranioplasty grafts. It was discovered that polyetheretherketone material did not offer any resistance to the bullet.…”