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Small Fragment Wounds: Biophysics, Pathophysiology and Principles of Management
  1. Maj PF Hill, M.Chir FRCS RAMC, Specialist Registrar in Trauma and Orthopaedic Surgery1,
  2. Maj DP Edwards, ChM FRCS Ed RAMC, Specialist Registrar in General Surgery2 and
  3. Mr GW Bowyer, M.Chir FRCS (Orth), Consultant in Trauma and Orthopaedics3
  1. 1Royal Defence Medical College, Gosport, Hampshire, PO12 2AB, U.K.
  2. 2Royal Defence Medical College, Gosport, Hampshire, PO12 2AB, U.K.
  3. 3Southampton General Hospital, Southampton, SO16 6YD


Military surgical doctrine has traditionally taught that all ballistic wounds should be formally managed by surgical intervention. There is now, however, both experimental and clinical evidence supporting the nonoperative treatment of selected small fragment wounds. Low energytransfer wounds affecting the soft tissues, without neuro-vascular compromise and with stable fracture patterns, may be suitable for early antibiotic treatment. The management of ballistic wounds to the gastrointestinal tract requires surgical intervention but, advances in the treatment of these wounds, especially those involving the colon, may allow more effective treatment with a reduced morbidity.

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