Gunshot wounds: 1. Bullets, ballistics, and mechanisms of injury.

Hollerman, Jeremy J.; Fackler, Martin L.; Coldwell, D M; Ben‐Menachem, Yoram

doi:10.2214/ajr.155.4.2119095

Cited by 183 publications

(103 citation statements)

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“…The two main mechanisms of wounding from projectile injury are from crushing and distortion of tissue. 28,44 When the tissue is crushed by the physical contact of the projectile, it creates a permanent cavity. This cavity is affected not only by the size of the bullet, but also by the yaw and any deformation of the projectile.…”

Section: Pathophysiology and Mechanism Of Injurymentioning

confidence: 99%

“…For example, if a bullet's yaw angle changes through its tissue track such that it angles up or down, then it makes more contact with tissue, thereby creating a larger permanent cavity and more crush injury. 28,44 Also, if the point of the bullet is a hollow-point or soft-point, then the bullet will deform upon contact and create a larger cross-sectional area of damaged tissue. In fact, military ammunition is required to have full metal casings (jackets) that prevent deformation while civilian ammunition is not, which allows for more deformation and a larger permanent cavity.…”

Section: Pathophysiology and Mechanism Of Injurymentioning

confidence: 99%

“…If a diver enters the water completely in-line with his or her long axis, there is minimal splash, but if the angle changes upon entry, then a large splash and resulting wave is created. 44 It should be noted that the yaw angle in flight remains relatively low, which allows normal long-axis entry into tissue, but as the yaw angle changes in tissue, there can be devastating consequences. 28 Finally, although the significance of temporary cavity formation in injury is debatable, it can play a large role in the injury of sensitive tissues such as the brain and liver, which have near-water density.…”

Section: Pathophysiology and Mechanism Of Injurymentioning

confidence: 99%

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An historical context of modern principles in the management of intracranial injury from projectiles

Agarwalla

Dunn

Laws

2010

FOC

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The contemporary management of projectile head injuries owes much to the lessons neurosurgeons have distilled from their experiences in war. Through early investigation and an increasingly detailed account of wartime clinical experience, neurosurgeons-including the field's early giants-began to gain a greater understanding not only of intracranial missile pathophysiology but also of appropriate management. In this paper, the authors trace the development of the principles of managing intracranial projectile injury from the Crimean War in the 19th century through the Vietnam War to provide a context that frames a summary of today's core management principles.

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Section: Pathophysiology and Mechanism Of Injurymentioning

confidence: 99%

Section: Pathophysiology and Mechanism Of Injurymentioning

confidence: 99%

Section: Pathophysiology and Mechanism Of Injurymentioning

confidence: 99%

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An historical context of modern principles in the management of intracranial injury from projectiles

Agarwalla

Dunn

Laws

2010

FOC

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“…However, high velocity bullets can have an explosive effect where when penetrating Unauthenticated Download Date | 5/10/18 11:34 PM soft tissues indirect fractures are caused to nearby bones (e.g. ribs or long bones) due to the expansion of the temporary cavity and the transfer of high energy (Clasper 2001;Hollerman et al 1990;Humphrey and Kumaratilake 2016;Janzon 1983;Mellor 1994;Stefanopoulos et al 2015).…”

Section: Discussionmentioning

confidence: 99%

Anthropological analysis of projectile trauma to the bony regions of the trunk

Humphrey¹,

Henneberg²

2017

Anthropological Review

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Ballistics literature often focuses on soft tissue injures and projectile trauma to the cranium. Minimal details on the bony characteristics of projectile trauma to the thorax/abdomen regions have been published. This study aims to analyse projectile trauma to the bony trunk region including the ribs, vertebrae, scapula, sternum and the hip bone to form a better understanding of the characteristics and biomechanics of skeletal trauma caused by a projectile and contribute to the existing database on skeletal trauma caused by projectiles. Fourteen cases of documented projectile trauma to the bony regions of the trunk from the Hamman-Todd Human Osteological Collection at the Cleveland Natural History Museum, Ohio were analysed. Of the 14 individuals with gunshot wounds examined, 40 wounds occurred to the bones. Twenty-four injuries to the ribs, 1 ilium, 11 vertebrae, 3 scapulae, and 1 sternum. Fracture patterns, heaving and bevelling can be used to determine the direction of travel of the projectile which can be evident on the ribs, sternum, scapula and ilium. It is critical to understand the wounding patterns associated with projectile trauma to the torso region as this is often targeted, due to being the centre of mass.

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“…Neural and vascular injuries are primary determinants of both mortality and long-term outcomes in these patients. [4][5][6] Extremity vascular injury and subsequent hemorrhage can induce hemodynamic instability and impact extremity viability. Fascial layer separation plays a central role in the pattern of injury due to the kinetic energy transfer involved in the immediate occurrence of the distal injury and late development of compartment syndrome.…”

Section: Discussionmentioning

confidence: 99%