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Bernard M, Dahlhausen CM, Kirk AM, Bernard A. Fragmenting projectiles: a case report and literature review of the G2 Radically Invasive Projectile. Trauma Surg Acute Care Open 2024; 9:e001355. [PMID: 38375026 PMCID: PMC10875469 DOI: 10.1136/tsaco-2023-001355] [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] [Received: 01/02/2024] [Accepted: 01/31/2024] [Indexed: 02/21/2024] Open
Abstract
Innovations in projectile design present unique challenges for trauma surgeons when treating gunshot victims. The G2 Radically Invasive Projectile (G2 Research, Winder, Georgia, USA) (G2RIP) is a frangible, rapidly expanding bullet resulting in a distinct pattern of injury consisting of diffuse hemorrhage with multicavity trauma as well as unique radiographic features of the projectile. To efficiently manage patients injured by the G2RIP, trauma surgeons must be aware of these distinct characteristics, and of previous patterns in effective management such as liberal damage control and extensive use of CT. Understanding previous presentation and management of patients injured by the G2RIP can aid in improving patient care in the trauma center.
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Affiliation(s)
- Matthew Bernard
- Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Christine M Dahlhausen
- Department of Surgery, The University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas, USA
| | - Andrew M Kirk
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Andrew Bernard
- Trauma and Acute Care Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
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Aaronson DM, Awad AJ, Hedayat HS. Lead toxicity due to retained intracranial bullet fragments: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE21453. [PMID: 36164673 PMCID: PMC9514260 DOI: 10.3171/case21453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 07/08/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lead toxicity (plumbism) secondary to retained lead bullet fragments is a rare complication in patients with gunshot wounds. To the authors' knowledge, there has been no definitive case reported of lead toxicity due to retained intracranial bullet fragments. OBSERVATIONS The authors reported the case of a 23-year-old man who presented after being found down. Computed tomography scanning of the head revealed bullet fragments within the calvaria adjacent to the left transverse sinus. During follow-up, he developed symptoms of plumbism with paresthesias in his bilateral hands and thighs, abdominal cramping, labile mood, and intermittent psychosis. Plumbism was confirmed with sequentially elevated blood lead levels (BLLs). The patient opted for surgical removal of the bullet fragments, which led to reduction in BLLs and resolution of his symptoms. LESSONS Although rare, lead toxicity from retained intracranial bullet fragments should be considered in patients who have suffered a gunshot wound to the head and have symptoms of lead toxicity with elevated BLLs. For safe and accessible intracranial bullet fragments in patients with plumbism, surgical intervention may be indicated.
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TRANSLATIONAL STUDY OF GUNSHOT INJURY TO THE COLON BY MODERN TYPES OF BULLETS. WORLD OF MEDICINE AND BIOLOGY 2022. [DOI: 10.26724/2079-8334-2022-4-82-192-196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Jiang M, Li Z, Liu K, Zhang R, Wu Z. Numerical study of the dynamic expansion behaviour of 9 mm expansion bullets in gelatine. Forensic Sci Int 2021; 329:111051. [PMID: 34688187 DOI: 10.1016/j.forsciint.2021.111051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
Due to their limited penetration power, expansion bullets are known for their good effectiveness and less endangerment to bystanders, thereby playing an important role in the fight against terrorism and violence. This study considered 20 bullet configurations with different shape parameters influencing the motion and deformation of 9 mm expansion bullets in gelatine. Owing to the constraints of high-speed photography, experimental observations have limitations. However, through numerical simulation, this study found that the penetration process of the 9 mm expansion bullets through biological tissues, as represented by the gelatine block in this study, can be subdivided into four stages. Further, the expansion bullet is highly sensitive to the impact velocity, and did not completely expand when travelling at speeds below the critical velocity and over-expanded when travelling at speeds above the threshold velocity. The results of this study revealed the interaction mechanism between expansion bullets and gelatine, which are significant to ballistic wounding assessment and treatment of expansion bullets.
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Affiliation(s)
- Mingfei Jiang
- School of Mechanical Engineering, Nanjing University of Science and Technology, Nanjing, Jiangsu, China 210094.
| | - Zhongxin Li
- School of Mechanical Engineering, Nanjing University of Science and Technology, Nanjing, Jiangsu, China 210094.
| | - Kun Liu
- School of Mechanical Engineering, Nanjing University of Science and Technology, Nanjing, Jiangsu, China 210094.
| | - Ruijie Zhang
- School of Mechanical Engineering, Nanjing University of Science and Technology, Nanjing, Jiangsu, China 210094.
| | - Zhilin Wu
- School of Mechanical Engineering, Nanjing University of Science and Technology, Nanjing, Jiangsu, China 210094.
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Zhang X, Cain MD, Williams CD, Spears TA, Poulos CK. G2 Research Radically Invasive Projectile: The Importance of Recognizing Its Imaging and Autopsy Patterns. Am J Forensic Med Pathol 2021; 42:248-251. [PMID: 33560647 DOI: 10.1097/paf.0000000000000669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Many fragmenting and frangible projectiles have been developed in the course of firearm history. In addition, partially because of the concerns of range and environmental contamination, bullets constructed without lead have become increasingly common. A case regarding a unique projectile that incorporates both features, the G2 Research Radically Invasive Projectile ammunition, is discussed in this article. Here we report a 25-year-old woman who died of multiple gunshot wounds caused by G2 Research Radically Invasive Projectile ammunition. Because of the bullet's unique design, the wounds demonstrated characteristic radiographic patterns and unique autopsy findings. Familiarity with these findings is important to forensic pathologists in terms of case documentation, projectile recovery, and personal safety.
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Affiliation(s)
- Xin Zhang
- From the Department of Pathology, Indiana University
| | | | | | - Timothy A Spears
- Indianapolis-Marion County Forensic Services Agency, Indianapolis, IN
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Alexopoulos G, Quadri N, Khan M, Bazai H, Formoso Pico C, Fraser C, Kulkarni N, Kemp J, Coppens J, Bucholz R, Mercier P. Ballistic lobar trajectory outcomes in civilian firearm penetrating brain injury. J Neurosurg 2021; 135:574-583. [PMID: 33157538 DOI: 10.3171/2020.6.jns201837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Penetrating brain injury (PBI) is the most lethal of all firearm injuries, with reported survival rates of less than 20%. The projectile trajectory (PT) has been shown to impact mortality, but the significant lobar tracks have not been defined. The aim of this retrospective case-control study was to test for associations between distinct ballistic trajectories, missile types, and patient outcomes. METHODS A total of 243 patients who presented with a PBI to the Saint Louis University emergency department from 2008 through 2019 were identified from the hospital registry. Conventional CT scans combined with 3D CT reconstructions and medical records were reviewed for each patient to identify distinct PTs. RESULTS A total of 65 ballistic lobar trajectories were identified. Multivariable regression models were used, and the results were compared with those in the literature. Penetrating and perforating types of PBI associated with bitemporal (t-statistic = -2.283, p = 0.023) or frontal-to-contralateral parietal (t-statistic = -2.311, p = 0.025) projectile paths were universally found to be fatal. In the group in which the Glasgow Coma Scale (GCS) score at presentation was lower than 8, a favorable penetrating missile trajectory was one that involved a single frontal lobe (adjusted OR 0.02 [95% CI 0.00-0.38], p = 0.022) or parietal lobe (adjusted OR 0.15 [95% CI 0.02-0.97], p = 0.048). Expanding or fragmenting types of projectiles carry higher mortality rates (OR 2.53 [95% CI 1.32-4.83], p < 0.001) than do nondeformable missiles. Patient age was not associated with worse outcomes when controlled by other significant predictive factors. CONCLUSIONS Patients with penetrating or perforating types of PBI associated with bitemporal or frontal-to-contralateral parietal PTs should be considered as potential donor candidates. Trauma patients with penetrating missile trajectories involving a single frontal or parietal lobe should be considered for early neurosurgical intervention, especially in the circumstances of a low GCS score (< 8). Surgeons should not base their decision-making solely on advanced patient age to defer further treatment. Patients with PBIs caused by nondeformable types of projectiles can survive multiple simultaneous intracranial missile trajectories.
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Affiliation(s)
- Georgios Alexopoulos
- 1Department of Neurosurgery and
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Nabiha Quadri
- 1Department of Neurosurgery and
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Maheen Khan
- 1Department of Neurosurgery and
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Henna Bazai
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | | | - Connor Fraser
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Neha Kulkarni
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Joanna Kemp
- 1Department of Neurosurgery and
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Jeroen Coppens
- 1Department of Neurosurgery and
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Richard Bucholz
- 1Department of Neurosurgery and
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
| | - Philippe Mercier
- 1Department of Neurosurgery and
- 2School of Medicine, Saint Louis University, St. Louis, Missouri
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Oliva A, Grassi S, Grassi VM, Pinchi V, Floris R, Manenti G, Colosimo C, Filograna L, Pascali VL. Postmortem CT and autopsy findings in nine victims of terrorist attack. Int J Legal Med 2021; 135:605-618. [PMID: 33420525 DOI: 10.1007/s00414-020-02492-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/17/2020] [Indexed: 12/26/2022]
Abstract
In a foreign country, a religious terrorist group raided a restaurant, using pipe bombs, sharp-edged weapons, and various types of firearms (handguns, submachine guns, and AK-47 assault rifles) loaded with normal and prohibited bullets to kill foreigner customers, some of whom were Italian tourists. Local pathologists performed forensic autopsies on the bodies, but we were asked to perform additional external examinations, postmortem computed tomography (PMCT) scans, and then a second round of complete autopsies on nine victims (5 females and 4 males). Four victims had slash wounds inflicted by sharp-edged weapons, mostly localized in the head and neck. All but two victims had gunshot wounds. Finally, three casualties had injuries caused by the explosion of improvised explosive devices. In all cases, PMCT was a reliable source of information and provided strategic guide during autopsies, helping identify and describe the injuries and thus reconstruct the events. Therefore, in these cases, we suggest integrating the autopsy findings with the postmortem radiological data.
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Affiliation(s)
- Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.
| | - Simone Grassi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Vincenzo M Grassi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Vilma Pinchi
- Section of Forensic Medical Sciences, Department of Health Sciences, University of Florence, Florence, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Rome, Italy
| | - Guglielmo Manenti
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Rome, Italy
| | - Cesare Colosimo
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology - Diagnostic Imaging Area, Fondazione Policlinico, Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Filograna
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Rome, Italy
| | - Vincenzo L Pascali
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
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Gascho D. Lodged bullets on computed tomography: Three classification procedures for the virtual investigation of bullets or their fragments that cannot be recovered from the living patient. MEDICINE, SCIENCE, AND THE LAW 2020; 60:245-248. [PMID: 33054596 DOI: 10.1177/0025802420962697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Dominic Gascho
- Department of Forensic Medicine and Imaging, Institute of Forensic Medicine, University of Zurich, Switzerland
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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: 2] [Impact Index Per Article: 0.5] [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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Radically Invasive Projectiles—first reports and imaging features of this new and dangerous bullet. Emerg Radiol 2020; 27:393-397. [DOI: 10.1007/s10140-020-01766-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/20/2020] [Indexed: 11/26/2022]
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