Crossbow injuries: A case report with experimental reconstruction study and a systematic review of literature

Ballistic Gels in Experimental Fracture Setting

Biomechanical tests typically involve bending, compression, or shear stress, while fall tests are less common. The main challenge in performing fall tests is the non-reproducible directionality of bone when tested with soft tissue. Upon removal of the soft tissue, the explanted bone's resistance to impact diminishes. Therefore, ballistic gels can fix specimens in reproducible directions and simulate periosteal soft tissue. However, the use of ballistic gels in biomechanical studies is neither standardized nor widespread. This study aimed to optimize a ballistic gel consistency that mimics the upper thigh muscle in sheep. Our results suggest a standardized and flexible evaluation method by embedding samples in ballistic gel. Compression tests were conducted using cylindrical pieces of gluteal muscle from sheep. Various compositions of agarose and gelatin mixtures were tested to achieve a muscle-like consistency. The muscle-equivalent ballistic gel was found to consist of 29.5% gelatin and 0.35% agarose. Bones remained stable within the ballistic gel setup after freeze-thaw cycles between -20 °C and +20 °C. This method reduces the variability caused by muscle and improves storage quality, allowing for tests to be conducted under consistent conditionsBallistic gels of agarose and gelatin are suitable for bone fracture models. They have muscle-like strength, fix fractures simultaneously, are inexpensive to produce, and can be stored to allow repeated measurements of the same object with changing questions.

Penetrating head and spine injuries due to artisanal Sahelian metal arrows: experience from a tertiary hospital in Niger

BACKGROUND AND OBJECTIVE

Metal arrows are medieval weapons typically used for hunting and war. The incidence of metal arrow wounds has declined considerably since the 16th century. Different metal arrowheads exist, and the traditional Sahelian arrowhead is barbed. Extraction of this type of metal arrow is challenging because of the risk of extensive damage to surrounding structures. To the best of our knowledge, there are no guidelines in the literature for intracranial and spinal penetrating Sahelian arrow injuries and their surgical extraction. Most authors referred to the principles of common trauma injury. In this study, we aimed to share our experience with the surgical extraction of intracranial and spinal artisanal Sahelian arrows leading to penetrating injuries, and to propose some guidelines for such lesions.

METHODS

We present a consecutive case series of 8 patients admitted to the Department of Neurosurgery of the National Hospital of Zinder for metal arrow injuries of the head and spine between November 2015 and June 2023.

RESULTS

Eight patients with penetrating head and spine barbed-arrow injuries were admitted to our department. Mean age was 19.37 years (range, 15 to 25 years). Patients were all male, from a rural area. Trauma circumstances involved fighting between farmers and herders. All patients received antibiotics, analgesics and tetanus prophylaxis at admission before undergoing surgical extraction under general anesthesia. Successful extraction was achieved in all cases.

CONCLUSION

Extraction of intracranial or spinal artisanal Sahelian arrows is a challenge, particularly in limited facility structures. The proposed guidelines may lead to good extraction outcomes.

Crossbow Injuries: Predictors of Mortality

INTRODUCTION

Crossbow injuries are rare but carry significant morbidity and mortality, and there is limited evidence in the medical literature to guide care. This paper reviews the case reports and case series of crossbow injuries and looks for trends regarding morbidity and mortality based on the type of arrow, anatomic location of injury, and intent of injury.

METHODS

Multiple databases were searched for cases of crossbow injuries and data were abstracted into a spreadsheet. Statistics were done in SPSS.

RESULTS

358 manuscripts were returned in the search. After deduplication and removal of nonclinical articles, 101 manuscripts remained. Seventy-one articles describing 90 incidents met the inclusion criteria. The mean age was 36.5 years. There were 10 female and 79 male victims. Fatality was 36% for injuries by field tip arrows and 71% for broadhead arrows, p  =  .024. Assaults were fatal in 84% of cases, suicides in 29%, and accidental injuries in 17%, p < .001. Mortality was similar for wounds to the head and neck (41%), chest (42%), abdomen (33%), extremities (50%), and multiple regions, p  =  .618.

CONCLUSIONS

Crossbows are potentially lethal weapons sold with fewer restrictions than firearms. Injuries caused by broadhead arrows are more likely to be fatal than injuries from field tip arrows. The anatomic location of injury does not correlate with fatality. More than half of crossbow injuries are due to attempted suicide, with a high case-fatality rate.

A unique case of suicide by crossbow with indirect triggering and cranial injury: forensic issues and literature review

Currently, crossbows are involved in some deaths, including suicides. These are rare events for which an accurate study of the body discovery site and reconstruction of the triggering mechanism of the crossbow represent crucial medicolegal elements. In this report, a unique case of suicide by crossbow is presented, in which the male victim constructed an elaborate scenario. He arranged two tripod stands to hold the crossbow at the height of his head, and a third to support a hollow tube positioned in front of the muzzle of the crossbow to direct the bolt. After positioning the center of the forehead in front of the hollow tube, the trigger was activated from a distance using a hooked metal rod. The methods used prompted a literature review on suicide by crossbow, which revealed only 14 reports from 1993 to 2023. The head and chest were the main target areas, and in almost all cases, the victims directly pulled the trigger with their finger. Only one case of indirect triggering was found, with the chest as the target. Therefore, in this scenario, the case presented stands as a unique report, due to the elaborate system devised to carry out the suicide and accurately strike the predetermined target.

Self-inflicted crossbow injury in the head: A case report

Injuries and deaths from crossbows are uncommon, especially when self-inflicted. We present here the case of a 45 years old patient with history of mental illness, who attempted suicide with a crossbow. The bolt penetrated the chin, crossed the oral floor, the oral cavity, the bony palate, the left nasal cavity and exited at the level of the nasal bones. The main concern was the management of the airways, before proceeding to the removal of the bolt. A nasotracheal intubation through the right nasal cavity while the patient was conscious was performed, but the instruments needed for an emergency tracheotomy were in the operating room in case of failure. The intubation was successful, he underwent general anesthesia, and the bolt was removed from the face.

Two Thumbs Down: A 10-Year Analysis of Crossbow-Related Hand and Digit Injuries in the United States

BACKGROUND

Modern crossbow is a popular weapon used throughout the United States for outdoor recreation. Crossbow mechanics place the hand and digits at significant risk of injury while shooting or handling these weapons; however, injury patterns have been poorly documented. In this study, the authors use a national database to assess patterns of crossbow-related injuries of the hand and digits.

METHODS

A retrospective review of the National Electronic Injury Surveillance System database was conducted to identify crossbow-related hand and digit injuries over the past 10 years. Demographic data, injury timing, anatomical injury location, specific injury diagnosis, and disposition data were collected.

RESULTS

A total of 15 460 crossbow-related hand injuries were identified between 2011 and 2021. A strong temporal relationship was identified, with 89% of injuries occurring between the months of August and December. Male patients sustained most injuries (>85%). Body areas injured were the digits (93.2%) and the hand (5.7%). The most common injuries were laceration (n = 7520, 48.6%), fracture (n = 4442, 28.7%), amputation (n = 1341, 8.7%), and contusion/abrasion (n = 957, 6.2%). More than 50% of cases involved injury to the thumb, with approximately 750 thumb amputations recorded during the time period examined.

CONCLUSIONS

This study is the first to document the patterns of hand and digit injuries associated with crossbow use on a national scale. These findings have important implications for public health awareness campaigns targeting hunters and support the designation of crossbow "safety wings" as a mandatory feature of crossbow design.