Gunshot Wound Review☆,☆☆,★

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Abstract

There is no serious argument about the wounding potential of various kinds of penetrating projectiles. The laws of physics in concert with modern bullet testing have clarified and quantified the mechanisms by which bullets disrupt tissue. Despite this scientific background, much misinformation persists in the wound-ballistics literature. This article reviews the interaction of penetrating projectiles with human tissue. Understanding of wound ballistics allows the emergency physician to become a more informed reader of its literature, as well as a more reliable provider of care to the wounded patient. [Fackler ML: Gunshot wound review. Ann Emerg Med August 1996;28:194-203.]

Section snippets

INTRODUCTION

From the Revolutionary War to the settling of our western frontier, small-arms use has been inextricably entwined with American history. Widespread use of firearms has induced scientists and physicians to define the basic principles of wound ballistics. Over the past century, the mechanisms by which penetrating projectiles injure living tissue have been extensively studied and explained. Yet mistaken ideas about bullet effects are still held today. The most common misconception about gunshot

CONTROVERSIES REGARDING WOUNDING POTENTIAL

In 1967, a group reported the wounds caused by M-16 rifle bullets in Vietnam as "massively destructive"1 and possessing "devastating wounding power . . . tremendous wounding and killing power".2 Because the 3,100 foot/second (945 m/second) muzzle velocity of the M-16 bullet was higher than that of previous military bullets, "high velocity" became synonymous with "devastating wounding power."

These subjective descriptions attracted the attention of Swedish researchers.3 In 1974, a Swedish

WOUNDING MECHANISMS

The objective measurement of a wound's dimensions, along with a clear and precise description of the tissue disruption (augmented by good-quality photographs including a measuring scale) is the only valid method of verifying the disruption caused by a given bullet. This method permits meaningful comparison of the disruptive effects caused by various bullets.10

Basic physics verifies that a projectile's potential to disrupt tissue is determined by both its mass and its velocity. Wounding

COMMUNICATION PROBLEMS IN WOUND BALLISTICS

Failure to adhere to the basic precepts of scientific method is the common denominator of misconceptions in wound ballistics.41 Good science is impossible without precise and clear communication, but the authors of most papers appearing in the wound-ballistics literature continue to use terms that are the antithesis of precision and clarity. These include the following.

High velocity The British draw their line between low and high velocity at 1,100 feet/second (335 m/second), which is the speed

PATHOPHYSIOLOGY OF GUNSHOT WOUND TREATMENT

There is little disagreement in the wound-ballistics literature about how to treat penetrating projectile wounds of the chest and abdomen or those that disrupt major blood vessels or bones. Ironically, most of the dispute and misunderstanding concerns treatment of the least lethal injuries: uncomplicated extremity wounds. Central to this dispute is how to manage the soft-tissue disruption.

Knowledge of the pathophysiology of penetrating projectile wounds is needed to choose the best treatment

References (59)

  • TE Bowen

    Missile-caused wounds, in Emergency War Surgery: NATO Handbook

  • KF King

    Orthopaedic aspects of war wounds in South Vietnam

    J Bone Joint Surg

    (1969)
  • ML Fackler et al.

    Wounding effects of the AK-47 rifle used by Patrick Purdy in the Stockton, California, schoolyard shooting of January 17, 1989

    Am J Forens Med Pathol

    (1990)
  • JH Davis et al.

    Clinical Surgery

    (1987)
  • D Dufour et al.

    Surgery for Victims of War

    (1988)
  • MS Owen-Smith

    High Velocity Missile Wounds

  • MG Ochsner et al.

    Complications of wounding agents

  • KG Swan et al.

    Gunshot Wounds: Pathophysiology and Management

  • SB Sheehy et al.

    Manual of Clinical Trauma

  • MM Sedwitz et al.

    Vascular trauma

  • W MacCormack

    Some points of interest in connexion with the surgery of war

    Lancet

    (1895)
  • T Longmore

    Gunshot Injuries

  • WF Stevenson

    Wounds in War

  • ML Fackler et al.

    The wound profile: A visual method for quantifying gunshot wound components

    J Trauma

    (1985)
  • ML Fackler

    The wound profile and the human body: Damage pattern correlation

    Wound Ballistics Rev

    (1994)
  • C Greenwood

    The political factors

  • ML Fackler

    Wounding patterns of military rifle bullets

    Int Def Rev

    (1989)
  • EN Harvey et al.

    Secondary damage in wounding due to pressure changes accompanying the passage of high velocity missiles

    Surgery

    (1947)

    • Cited by (0)

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    Dr Fackler is president of the International Wound Ballistics Association.

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    Address for reprints: Martin L Fackler, MD, Rural Route 4, Box 264, Hawthorne, Florida 32640, 352-481-5661

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    Reprint no. 47/1/74504

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