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Hancock A, Giffen M. Two Bullet Wounds, One Bullet: The Atypical Fragmentation of a .223 Caliber Ammunition. Am J Forensic Med Pathol 2024; 45:77-80. [PMID: 38305300 DOI: 10.1097/paf.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
ABSTRACT As the fifth leading cause of death in individuals aged 1 to 64 years in the United States, forensic pathologists frequently encounter firearm-related deaths and are trained to approach these cases by utilizing information from the investigation, radiographs, and autopsy findings to discern the logical sequence of events that lead to death. We also emphasize the importance and utility of various factors such as bullet wound characteristics, type of ammunition used, and type of tissues involved in a forensic pathologist's determination of events and in medicolegal investigations. However, the unusual presentations of firearm-related deaths can cause confusion and even frustration when there are contradicting circumstances or findings at work. We present the case of a 61-year-old woman with an atypical pattern of 2 distinct irregular entrance gunshot wounds determined to be caused by a single projectile.
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Affiliation(s)
- Addie Hancock
- From the Wake Forest University School of Medicine, Winston-Salem, NC
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2
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Singh NP, Sharma RK, Patil A. Gunshot Injury to the Face With Atypical Non-linear Bullet Trajectory: A Case Report. Cureus 2023; 15:e43917. [PMID: 37746495 PMCID: PMC10512756 DOI: 10.7759/cureus.43917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
The disruptive effect of firearm missiles on body tissues depends on many factors. However, it mainly relates to the bullet's physical and dynamic properties and tissue-related factors. We encountered an unusual case of a gunshot injury wherein the bullet traversed the neck with an upward and non-linear trajectory with an exit from the contralateral side of the neck without damaging any vital neck organs. A 26-year-old male presented with a gunshot wound to the chin from close range. A bullet entry hole was observed on the right side of the chin, encircled by the abrasion collar, with tattoo marks around the area. The patient was conscious, with normal vital signs and no injury to the cranial nerves or aerodigestive tract. The CT imaging of the patient revealed the injury tract traversing through the muscles of the floor of the mouth to involve the left carotid and left parapharyngeal space, along with the left sternocleidomastoid muscle, with an exit hole below the left mastoid in the posterior triangle of the neck. A bullet usually travels through the body in a straight line or pathway; however, its non-linear trajectories depend on the projectile's dynamics and its interaction with the body tissues. The present case emphasizes understanding wound ballistics to know the erratic bullet trajectories in the victim's body and their interpretation, irrespective of their entry site.
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Affiliation(s)
- Nilabh P Singh
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Ravi Kumar Sharma
- Forensic Medicine, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Amit Patil
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Patna, Patna, IND
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Surface wave analysis of the skin for penetrating and non-penetrating projectile impact in porcine legs. Forensic Sci Med Pathol 2023; 19:34-43. [PMID: 36100841 DOI: 10.1007/s12024-022-00521-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/27/2022]
Abstract
Secondary blast injuries may result from high-velocity projectile fragments which ultimately increase medical costs, reduce active work time, and decrease quality of life. The role of skin penetration requires more investigation in energy absorption and surface mechanics for implementation in computational ballistic models. High-speed ballistic penetration studies have not considered penetrating and non-penetrating biomechanical properties of the skin, including radial wave displacement, resultant surface wave speed, or projectile material influence. A helium-pressurized launcher was used to accelerate 3/8″ (9.525 mm) diameter spherical projectiles toward seventeen whole porcine legs from seven pigs (39.53 ± 7.28 kg) at projectile velocities below and above V50. Projectiles included a mix of materials: stainless steel (n = 26), Si3N4 (n = 24), and acetal plastic (n = 24). Tracker video analysis software was used to determine projectile velocity at impact from the perpendicular view and motion of the tissue displacement wave from the in-line view. Average radial wave displacement and surface wave speed were calculated for each projectile material and categorized by penetrating or non-penetrating impacts. Two-sample t-tests determined that non-penetrating projectiles resulted in significantly faster surface wave speeds in porcine skin for stainless steel (p = 0.002), plastic (p = 0.004), and Si3N4 ball bearings (p = 0.014), while ANOVA determined significant differences in radial wave displacement and surface wave speed between projectile materials. Surface wave speed was used to quantify mechanical properties of the skin including elastic modulus, shear modulus, and bulk modulus during ballistic impact, which may be implemented to simulate accurate deformation behavior in computational impact models.
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Pathophysiology, Classification and Comorbidities after Traumatic Spinal Cord Injury. J Pers Med 2022; 12:jpm12071126. [PMID: 35887623 PMCID: PMC9323191 DOI: 10.3390/jpm12071126] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 12/25/2022] Open
Abstract
The spinal cord is a conduit within the central nervous system (CNS) that provides ongoing communication between the brain and the rest of the body, conveying complex sensory and motor information necessary for safety, movement, reflexes, and optimization of autonomic function. After a spinal cord injury (SCI), supraspinal influences on the spinal segmental control system and autonomic nervous system (ANS) are disrupted, leading to spastic paralysis, pain and dysesthesia, sympathetic blunting and parasympathetic dominance resulting in cardiac dysrhythmias, systemic hypotension, bronchoconstriction, copious respiratory secretions and uncontrolled bowel, bladder, and sexual dysfunction. This article outlines the pathophysiology of traumatic SCI, current and emerging methods of classification, and its influence on sensory/motor function, and introduces the probable comorbidities associated with SCI that will be discussed in more detail in the accompanying manuscripts of this special issue.
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Daniels JS, Albakry I, Braimah RO, Samara MI, Albalasi RA, Al-Rayshan SM. Management of Maxillofacial Gunshot Injuries With Emphasis on Damage Control Surgery During the Yemen Civil War. Review of 173 Victims From a Level 1 Trauma Hospital in Najran, Kingdom of Saudi Arabia. Craniomaxillofac Trauma Reconstr 2022; 15:58-65. [PMID: 35265279 PMCID: PMC8899348 DOI: 10.1177/19433875211012211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design Studies on the concept of Damage Control Surgery (DCS) in the management of firearm injuries to the oral and maxillofacial region are still scarce, hence the basis for the current study. Objectives The objectives of the current study is to share our experience in the management of maxillofacial gunshot injuries with emphasis on DCS and early definitive surgery. Methods This was a retrospective study of combatant Yemeni patients with maxillofacial injuries who were transferred across the border from Yemen to Najran, Kingdom of Saudi Arabia. Demographics and etiology of injuries were stored. Paths of entry and exit of the projectiles were also noted. Also recorded were types of gunshot injury and treatment protocols adopted. Data was stored and analyzed using IBM SPSS Statistics for Windows Version 25 (Armonk, NY: IBM Corp). Results A total of 408 victims, all males, were seen during the study period with 173 (42.4%) males sustaining gunshot injuries to the maxillofacial region. Their ages ranged from 21 to 56 years with mean ± SD (27.5 ± 7.6) years. One hundred and twenty-one (70.0%) victims had extraoral bullet entry, while 53 (30.0%) victims had intraoral entry route. Ocular injuries, consisting of 25 (14.5%) cases of ruptured globe and 6 (3.5%) cases of corneal injuries, were the most commonly associated injuries. A total of 78 (45.1%) hemodynamically unstable victims had DCS as the adopted treatment protocol while early definitive surgery was carried out in 47(27.2%) hemodynamically stable victims. ORIF was the treatment modality used for the fractures in 132 (76.3%) of the victims. Conclusions We observed that 42.4% of the war victims sustained gunshot injuries. DCS with ORIF was the main treatment protocol adopted in the management of the hemodynamically unstable patients.
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Affiliation(s)
- John S. Daniels
- Department of Oral and Maxillofacial Surgery, King Khalid Hospital, Najran, Kingdom of Saudi Arabia
| | - Ibrahim Albakry
- Department of Oral and Maxillofacial Surgery, King Khalid Hospital, Najran, Kingdom of Saudi Arabia
| | - Ramat O. Braimah
- Department of Oral and Maxillofacial Surgery, Specialty Regional Dental Center, Najran, Kingdom of Saudi Arabia,Ramat O. Braimah, FWACS, Department of Oral and Maxillofacial Surgery, Specialty Regional Dental Center, Najran, Kingdom of Saudi Arabia.
| | - Mohammed I. Samara
- Department of Oral and Maxillofacial Surgery, King Khalid Hospital, Najran, Kingdom of Saudi Arabia
| | - Rabea A. Albalasi
- Department Oral and Maxillofacial Surgery, Sharorah General Hospital, Kingdom of Saudi Arabia
| | - Saleh M.A. Al-Rayshan
- Department of Oral and Maxillofacial Surgery, Khobash General Hospital, Khobash, Saudi Arabia
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Jabara JT, Gannon NP, Vallier HA, Nguyen MP. Management of Civilian Low-Velocity Gunshot Injuries to an Extremity. J Bone Joint Surg Am 2021; 103:1026-1037. [PMID: 33755646 DOI: 10.2106/jbjs.20.01544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Despite an increasing rate of civilian low-velocity gunshot injuries, there remains a lack of evidence-based treatment standards. ➤ Most low-velocity gunshot-induced fractures of the extremity can be managed similarly to non-gunshot-induced fractures, with the goals of restoring function and minimizing complications. ➤ There are a limited number of high-quality studies to support the use of prophylactic antibiotics for nonoperatively treated gunshot wounds. ➤ Intra-articular retained bullets should be removed, while prophylactic irrigation and debridement for a transarticular bullet is not routinely warranted for infection prevention. ➤ Much of the literature on low-velocity gunshot wounds is Level-III or IV evidence, warranting the need for higher-powered, randomized, prospective investigations.
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Affiliation(s)
- Justin T Jabara
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Nicholas P Gannon
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Heather A Vallier
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Mai P Nguyen
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
- Department of Orthopaedic Surgery, Regions Hospital, Saint Paul, Minnesota
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Goldman C, Shaw N, du Plessis D, Myers JB, van der Merwe A, Venkatesan K. Gunshot wounds to the penis and scrotum: a narrative review of management in civilian and military settings. Transl Androl Urol 2021; 10:2596-2608. [PMID: 34295746 PMCID: PMC8261456 DOI: 10.21037/tau-20-1175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022] Open
Abstract
Gunshot wounds (GSW) to the penis and scrotum are present in two thirds of all genitourinary (GU) trauma, with a growing proportion of blast injuries in the military setting. Depending on the energy of the projectile, the injury patterns present differently for military and civilian GSWs. In this review, we sought to provide a detailed overview of GSWs to the external genitalia, from mechanisms to management. We examine how ballistic injury impacts tissues, as well as the types of injuries that occur, and how to assess these injuries to the external genitalia. If there is concern for injury to the deep structures of the penis or scrotum, operative exploration and repair is warranted. Relevant history and physical examination, role of imaging, and choice of conservative or surgical treatment options in the civilian and military setting are discussed, as well as guidelines for management set forth by the American Urological Association (AUA) and European Association of Urology (EAU).
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Affiliation(s)
- Charlotte Goldman
- Georgetown University School of Medicine, Department of Urology, Washington, DC, USA
| | - Nathan Shaw
- Georgetown University School of Medicine, Department of Urology, Washington, DC, USA
| | - Danelo du Plessis
- Division of Urology, Department of Surgical Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Andre van der Merwe
- Division of Urology, Department of Surgical Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Krishnan Venkatesan
- Georgetown University School of Medicine, Department of Urology, Washington, DC, USA.,MedStar Washington Hospital Center, Department of Urology, Washington, DC, USA
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Sodagari F, Katz DS, Menias CO, Moshiri M, Pellerito JS, Mustafa A, Revzin MV. Imaging Evaluation of Abdominopelvic Gunshot Trauma. Radiographics 2020; 40:1766-1788. [DOI: 10.1148/rg.2020200018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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The G2 research R.I.P. fragmenting bullet-radiographic features of a recently encountered projectile. Skeletal Radiol 2020; 49:1663-1668. [PMID: 32504097 DOI: 10.1007/s00256-020-03486-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/15/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023]
Abstract
Gunshot wounds (GSWs) are an important cause of disability and death in the USA. Although radiography is limited in its ability to detect bullet types, a projectile introduced during the last decade, the R.I.P. bullet by G2 Research, consists of a base slug connected to 6 to 8 sharp trocars designed to diverge within soft tissue following impact, resulting in what we believe to be a unique imaging appearance that can be confusing to those not familiar with this particular projectile. Furthermore, this bullet is 100% copper, which may allow for safe imaging with magnetic resonance imaging if correctly identified prior to scanning.
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Durso AM, Paes FM, Caban K, Danton G, Braga TA, Sanchez A, Munera F. Evaluation of penetrating abdominal and pelvic trauma. Eur J Radiol 2020; 130:109187. [DOI: 10.1016/j.ejrad.2020.109187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/11/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022]
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da Rocha SS, Sales PHDH, Carvalho PHR, Maia RN, Gondim RF, de Menezes Junior JMS, Mello MDJR. Mandibular traumas by gunshot. A systematic review with meta-analysis and algorithm of treatment. Br J Oral Maxillofac Surg 2020; 59:e99-e108. [PMID: 33678448 DOI: 10.1016/j.bjoms.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
The treatment of mandibular fractures by gunshot ranges from late conservative repair to more aggressive early repair in a single stage. Treatments that preserve bony architecture as much as possible should be used, minimising patient morbidity and the complexity of future surgeries. The purpose of this study was to use a systematic review to determine which method of treatment was most effective for mandibular fractures by gunshot. Searches were conducted on Medline via PubMed, Scopus, Central Cochrane, and Sigle via Open Grey up to August 2019. Four studies were eligible to this systematic review, considering the previously establish inclusion and exclusion criteria. A total of 211 patients were evaluated. The mandibular body was the region more fractured followed by the symphyseal/parasymphyseal region. The closed treatment with intermaxillary fixation (IMF) was the most used followed by open surgery with internal rigid fixation (IRF) and external fixator. Considering the total adverse effects, the meta-analysis showed no statistically significant difference between the IMF and IRF groups (p=0.840), but IMF showed five times less infection and IRF six times less malunion. The algorithm was delineated from the types of injuries by gunshot, proposing forms of treatment from initial stabilisation to functional rehabilitation with implant-supported prostheses. The treatment of mandibular fractures by gunshot remains a challenge for surgeons. There was a statistically significant prevalence of success in the IRF group, however this group was also associated with a higher index of infection than the IMF group. New studies with high methodological quality and larger numbers of participants are needed to offer more safety for surgeons who treat patients with mandibular fractures by gunshot.
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Stokke S, Arnemo JM, Brainerd S. Unleaded hunting: Are copper bullets and lead-based bullets equally effective for killing big game? AMBIO 2019; 48:1044-1055. [PMID: 30919260 PMCID: PMC6675831 DOI: 10.1007/s13280-019-01171-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/14/2019] [Accepted: 03/08/2019] [Indexed: 05/19/2023]
Abstract
Semi-jacketed lead-cored or copper-based homogenous rifle bullets are commonly used for hunting big game. Ever since their introduction in the 1990's, copper-based bullets have not been widely accepted by hunters due to limited supply, higher expense, and the perception that they exhibit inferior killing efficiency and correspondingly higher wounding rates. Here, we present data showing that animal flight distances for roe deer, red deer, brown bear, and moose dispatched with lead- or copper-based hunting bullets did not significantly differ from an animal welfare standardized animal flight distance based on body mass. Lead-cored bullets typical fragment on impact, whereas copper-based bullets retain more mass and expand more than their leaden counterparts. Our data demonstrate that the relative killing efficiency of lead and copper bullets is similar in terms of animal flight distance after fatal shots. Hunters that traditionally use lead bullets should consider switching to copper bullets to enhance human and environmental health.
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Affiliation(s)
- Sigbjørn Stokke
- Norwegian Institute for Nature Research, P.O. Box 5685, Torgard, 7485 Trondheim, Norway
| | - Jon M. Arnemo
- Inland Norway University of Applied Sciences, Campus Evenstad, 2480 Koppang, Norway
| | - Scott Brainerd
- Division of Wildlife Conservation, Alaska Department of Fish and Game, 1300 College Road, Fairbanks, AK 99701 USA
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von Lübken F, Achatz G, Friemert B, Mauser M, Franke A, Kollig E, Bieler D. [Update on gunshot wounds to extremities]. Unfallchirurg 2019; 121:59-72. [PMID: 29260242 DOI: 10.1007/s00113-017-0449-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Due to recent rampage and terror attacks in Europe, gunshot wounds have become a focus of attention even though they are still rare in Europe. Approximately 50% of gunshot wounds affect the extremities and to understand the sequelae, a basic knowledge of wound ballistics is indispensable. The energy transmitted from the bullet to the tissue is responsible for the severity of the injury and is dependent on the type of weapon and ammunition. A differentiation is made between low-energy injuries caused, e.g. by pistols and high-energy injuries mostly caused by rifles. The higher energy transfer to the tissue in high-energy injuries, results in a temporary wound cavity in addition to the permanent wound channel with extensive soft tissue damage. High-energy gunshot fractures are also more extensive compared to those of low energy injuries. Debridement seems to be necessary for almost all gunshot wounds. Fractures should be temporarily stabilized with an external fixator due to contamination.
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Affiliation(s)
- F von Lübken
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
| | - G Achatz
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - B Friemert
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - M Mauser
- Trauma Directorate, Chris Hani Baragwanath Academic Hospital, Johannesburg, Südafrika
| | - A Franke
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs‑, Hand- und Plastische Chirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
| | - E Kollig
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs‑, Hand- und Plastische Chirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
| | - D Bieler
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs‑, Hand- und Plastische Chirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
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Gurunluoglu R, Gatherwright J. Microsurgical reconstruction of complex maxillofacial gunshot wounds: Outcomes analysis and algorithm. Microsurgery 2019; 39:384-394. [DOI: 10.1002/micr.30418] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 11/28/2018] [Accepted: 12/12/2018] [Indexed: 11/11/2022]
Affiliation(s)
| | - James Gatherwright
- Department of Plastic Surgery; MetroHealth & Veterans Affairs; Cleveland Ohio
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Stokke S, Arnemo JM, Brainerd S, Söderberg A, Kraabøl M, Ytrehus B. Defining animal welfare standards in hunting: body mass determines thresholds for incapacitation time and flight distance. Sci Rep 2018; 8:13786. [PMID: 30214004 PMCID: PMC6137050 DOI: 10.1038/s41598-018-32102-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/31/2018] [Indexed: 11/10/2022] Open
Abstract
Shooting is an important tool for managing terrestrial wildlife populations worldwide. To date, however, there has been few quantitative methods available enabling assessment of the animal welfare outcomes of rifle hunting. We apply a variety of factors to model flight distance (distance travelled by an animal after bullet impact) and incapacitation from the moment of bullet impact. These factors include body mass, allometric and isometric scaling, comparative physiology, wound ballistics and linear kinematics. This approach provides for the first time a method for quantifying and grading the quality of shooting processes by examining only body mass and flight distance. Our model is a universally applicable tool for measuring animal welfare outcomes of shooting regimes both within and among species. For management agencies the model should be a practical tool for monitoring and evaluating animal welfare outcomes regarding shooting of mammalian populations.
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Affiliation(s)
- Sigbjørn Stokke
- Norwegian Institute for Nature Research, P.O. Box 5685 Torgard, NO-7485, Trondheim, Norway.
| | - Jon M Arnemo
- Inland Norway University of Applied Sciences, Campus Evenstad, Postboks 400, 2418, Elverum, Norway
- Department of Wildlife, Fish, and Environmental Studies, Swedish University of Agricultural Sciences, SE-90183, Umeå, Sweden
| | - Scott Brainerd
- Alaska Department of Fish and Game, Division of Wildlife Conservation, 1300 College Road, Fairbanks, AK, 99701, USA
- Department of Ecology and Natural Resource Management, Norwegian University of Life Sciences, P.O. Box 5003, NO-1432, Ås, Norway
| | - Arne Söderberg
- National Veterinary Institute, SVA, SE-75189, Uppsala, Sweden
- County Administrative Board, Box 22067, 104 22, Stockholm, Sweden
| | - Morten Kraabøl
- Norwegian Institute for Nature Research, P.O. Box 5685 Torgard, NO-7485, Trondheim, Norway
- Multiconsult Norway AS, Postboks 265 Skøyen, NO-0213, Oslo, Norway
| | - Bjørnar Ytrehus
- Norwegian Institute for Nature Research, P.O. Box 5685 Torgard, NO-7485, Trondheim, Norway
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Humphrey C, Henneberg M, Wachsberger C, Kumaratilake J. Comparison of porcine organs and commonly used ballistic simulants when subjected to impact from steel spheres fired at supersonic velocities. Forensic Sci Int 2018; 288:123-130. [DOI: 10.1016/j.forsciint.2018.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/11/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
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17
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Iverson KR, Curtis E, Brown IE, Salcedo ES, Anderson JT. New fragmenting bullet leads to unexpected injury pattern: A case report involving the Radically Invasive Projectile. TRAUMA-ENGLAND 2018. [DOI: 10.1177/1460408618759365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
New developments in bullet technology are challenging what is commonly known about penetrating injuries from gunshot wounds. The so-called ‘bullet-rule’ posits the number of wounds and projectiles associated with a patient should add to an even number. This trauma paradigm is being shattered by the advent of new fragmenting projectiles. These frangible rounds break into several pieces after soft tissue penetration changing the expected trajectory, injury location, and extent of tissue damage. In this case report, the authors describe the case of a 15-year-old boy injured by a G2 Radically Invasive Projectile (RIP). The patient’s resultant pattern of injuries and the diagnostic utility of imaging were imperative for guiding his clinical management. The case serves as a useful example of the challenges and recommended strategies in managing a patient injured by a new fragmenting bullet.
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Affiliation(s)
| | - Eleanor Curtis
- Department of Surgery, University of California Davis, Sacramento, USA
| | - Ian E Brown
- Department of Surgery, University of California Davis, Sacramento, USA
| | - Edgardo S Salcedo
- Department of Surgery, University of California Davis, Sacramento, USA
| | - John T Anderson
- Department of Surgery, University of California Davis, Sacramento, USA
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Lan ZG, Richard SA, Li J, Yang C. Nonprojectile penetrating iron rod from the oral cavity to the posterior cranial fossa: a case report and review of literature. Int Med Case Rep J 2018; 11:41-45. [PMID: 29563841 PMCID: PMC5849932 DOI: 10.2147/imcrj.s157237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction Nonprojectile penetrating skull base injuries as a result of falls have rarely been confronted in normal neurosurgery although a few nonmissile injuries have been reported. These kinds of injuries represent a life-threatening emergency. Case presentation We present an unusual case of a 25-year-old male construction worker who suffered an accidental penetrating skull base injury when he fell on a metal rod while he was walking on a 2-meter-high platform. He was clinically stable at presentation. Skull radiograph showed a solid metallic bar, 30 cm long, that penetrated through the right anguli oris eminence and was lodged low in the right occipital bone. Conclusion Penetrating injury to the head is considered a form of severe traumatic brain injury. Although case of penetrating head injuries as a result of fall from heights are very rare, we anticipate the construction works on high-rise buildings are at maximum risk. We advise that removal of this kind of foreign bodies be done in the theater and not outside because of risk of involvement of larger vessels leading to fatal hemorrhage. We further suggest that patients with nonprojectile injuries should undergo a preoperative computed tomography-angiography to rule out any vascular injury.
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Affiliation(s)
- Zhi Gang Lan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Seidu A Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Department of Immunology, Jiangsu University, Zhenjiang, Jiangsu, People's Republic of China.,Department of Surgery, Volta Regional Hospital, Ho, Ghana, West Africa
| | - Jin Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Chaohua Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Management of High-energy Avulsive Ballistic Facial Injury: A Review of the Literature and Algorithmic Approach. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1693. [PMID: 29707453 PMCID: PMC5908512 DOI: 10.1097/gox.0000000000001693] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/12/2018] [Indexed: 01/13/2023]
Abstract
Background: High-energy avulsive ballistic facial injuries pose one of the most significant reconstructive challenges. We conducted a systematic review of the literature to evaluate management trends and outcomes for the treatment of devastating ballistic facial trauma. Furthermore, we describe the senior author’s early and definitive staged reconstructive approach to these challenging patients. Methods: A Medline search was conducted to include studies that described timing of treatment, interventions, complications, and/or aesthetic outcomes. Results: Initial query revealed 41 articles, of which 17 articles met inclusion criteria. A single comparative study revealed that early versus delayed management resulted in a decreased incidence of soft-tissue contracture, required fewer total procedures, and resulted in shorter hospitalizations (level 3 evidence). Seven of the 9 studies (78%) that advocated delayed reconstruction were from the Middle East, whereas 5 of the 6 studies (83%) advocating immediate or early definitive reconstruction were from the United States. No study compared debridement timing directly in a head-to-head fashion, nor described flap selection based on defect characteristics. Conclusions: Existing literature suggests that early and aggressive intervention improves outcomes following avulsive ballistic injuries. Further comparative studies are needed; however, although evidence is limited, the senior author presents a 3-stage reconstructive algorithm advocating early and definitive reconstruction with aesthetic free tissue transfer in an attempt to optimize reconstructive outcomes of these complex injuries.
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Update zu Schussverletzungen der Extremitäten. Notf Rett Med 2018. [DOI: 10.1007/s10049-018-0424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Bede S, Ismael W, Al-Assaf D. Characteristics of mandibular injuries caused by bullets and improvised explosive devices: a comparative study. Int J Oral Maxillofac Surg 2017; 46:1271-1275. [DOI: 10.1016/j.ijom.2017.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 05/13/2017] [Accepted: 06/29/2017] [Indexed: 11/26/2022]
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Raja A, Ahmad S, Ehmed S, Blume T, Fai EK, Khan AS. Chronic Expanding Hematoma in the Dorsal Cervicothoracic Region as a Long-Term Complication of Retained Bullet Fragments: Case Report. Cureus 2016; 8:e858. [PMID: 27917326 PMCID: PMC5133135 DOI: 10.7759/cureus.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Chronic expanding hematoma is a rare pathology, which has not been previously described as a complication of gunshot injury with retained bullet fragments. Because of the similar characteristics of chronic expanding hematoma to malignancy, it can present a diagnostic challenge for clinicians. Imaging and biopsy evaluation is needed to reach a conclusive diagnosis and implement appropriate treatment. In this case report, we will discuss the development, diagnosis, and management of a chronic superficial cervicothoracic mass in a patient who presented 30 years post-gunshot injury with retained bullet fragments.
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Affiliation(s)
- Avais Raja
- Department of Orthopaedic Surgery, Shifa College of Medicine, Islamabad, Pakistan
| | | | - Salman Ehmed
- Emergency Medicine, Kings Edward Medical University
| | - Terri Blume
- Neurosurgery, University of Maryland Medical Center Midtown Campus
| | - Emmanuel K Fai
- Neurosurgery, University of Maryland Medical Center Midtown Campus
| | - Agha S Khan
- Neurosurgery, University of Maryland Medical Center Midtown Campus
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Humphrey C, Kumaratilake J. Ballistics and anatomical modelling – A review. Leg Med (Tokyo) 2016; 23:21-29. [DOI: 10.1016/j.legalmed.2016.09.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 08/22/2016] [Accepted: 09/05/2016] [Indexed: 01/02/2023]
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Hsu MJ, Gupta A, Soto JA, LeBedis CA. Imaging of Torso and Extremity Vascular Trauma. Semin Roentgenol 2016; 51:165-79. [DOI: 10.1053/j.ro.2016.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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26
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Spinal cord injury resulting from gunshot wounds: a comparative study with non-gunshot causes. Spinal Cord 2016; 54:737-41. [DOI: 10.1038/sc.2016.29] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/17/2016] [Accepted: 02/02/2016] [Indexed: 11/08/2022]
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Abstract
This article discusses the role of radiology in evaluating patients with penetrating injuries to the chest. Penetrating injuries to the chest encompass ballistic and nonballistic injuries and can involve superficial soft tissues of the chest wall, lungs and pleura, diaphragm, and mediastinum. The mechanism of injury in ballistic and nonballistic trauma and the impact the injury trajectory has on imaging evaluation of penetrating injuries to the chest are discussed. The article presents the broad spectrum of imaging findings a radiologist encounters with penetrating injuries to the chest, with emphasis on injuries to the lungs and pleura, diaphragm, and mediastinum.
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Affiliation(s)
- Anthony M Durso
- Department of Radiology, Jackson Memorial Hospital/Ryder Trauma Center, University of Miami Miller School of Medicine, 1611 Northwest, 12th Avenue, WW-279, Miami, FL 33136, USA
| | - Kim Caban
- Department of Radiology, Jackson Memorial Hospital/Ryder Trauma Center, University of Miami Miller School of Medicine, 1611 Northwest, 12th Avenue, WW-279, Miami, FL 33136, USA
| | - Felipe Munera
- Department of Radiology, Jackson Memorial Hospital/Ryder Trauma Center, Radiology Services, University of Miami Hospitals, University of Miami Miller School of Medicine, 1611 Northwest, 12th Avenue, WW-279, Miami, FL 33136, USA.
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Firearms, bullets, and wound ballistics: an imaging primer. Injury 2015; 46:1186-96. [PMID: 25724396 DOI: 10.1016/j.injury.2015.01.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 01/21/2015] [Accepted: 01/23/2015] [Indexed: 02/02/2023]
Abstract
Based on its intrinsic mass and velocity, a bullet has an upper limit of wounding potential. Actual wound severity is a function of the bullet construction and trajectory, as well as the properties of the tissues traversed. Interpreting physicians must evaluate the bullet trajectory and describe patterns of injury resulting from the effect of energy transfer from the projectile into living tissue. A basic understanding of firearms, projectiles, and wound ballistics can help the interpreting physicians in conceptualizing these injuries and interpreting these cases.
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The experimental and numerical investigation of pistol bullet penetrating soft tissue simulant. Forensic Sci Int 2015; 249:271-9. [DOI: 10.1016/j.forsciint.2015.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 02/02/2015] [Accepted: 02/12/2015] [Indexed: 11/20/2022]
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Stefanopoulos PK, Hadjigeorgiou GF, Filippakis K, Gyftokostas D. Gunshot wounds: A review of ballistics related to penetrating trauma. JOURNAL OF ACUTE DISEASE 2014. [DOI: 10.1016/s2221-6189(14)60041-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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