Non-metallic and metallic craniocerebral missile injuries: Varied outcome

Abstract

We studied the comparative outcome related to 694 non-metallic and metallic craniocerebral missile injuries who lived at 2 hours and beyond the time of injury in a retrospective and prospective analysis in the Department of Neurosurgery at Sher-I-Kashmir Institute of Medical Sciences (SKIMS) Kashmir, India, over a period of 21 years from September 1988 to March, 2010. The study revealed an overall mortality of 32.70% (227 out of 694). A total of 664 adults and 30 children (mostly teenagers) were studied. The 79.1% (549 out of 694) patients were metallic missile injuries whereas 20.8% (145 out of 694) patients were non-metallic missile injuries. The non-metallic missile injury group mostly (72.4% i.e.; 105 out of 145) had low GCS score and overall worse prognosis with zero good-recovery, 47.5% disabilities and 52.4% mortality as compared to the metallic missile injury group. The non-metallic group comprised of 60% (18 out of 30) children with one death. Non-metallic missile injuries accounted for 10.95% (76 out of 694 patients) of total deaths. Predictors of poor outcome were low admission GCS score, non-metallic penetrating injury due to tear-gas cartridges, rubber bullets and stone-bullets, perforating metallic missile injuries and delayed and maltransportation. Most complications in non-metallic missile injuries were infective and had poor outcome. The common non-metallic missiles used were stone bullets (balls) fired by Gulail (modified catapult) or slingshot, red rubber bullets, plastic tear gas shells and cartridges, wooden (pulped mulberry stem) and card-board wads used in shotguns. The stone pelting, throwing stone projectiles (stone-bullets) by Gulail and manually has become a common way to inflict head injuries in Kashmir. The non-metallic missiles are not less-lethal and have high disabling, killing and infective potential.

Reverse-Penetrating Head Injury Caused by Falling on Sharp-Edged Stone: A Case Report

“…2,4,5 The nonmetallic missile injuries are probably the most contaminated penetrating injuries due to their vegetative and infective nature. 6 The pathophysiology of penetrating head injury depends on the kinetic energy and trajectory of the object through the brain. The principle of missile injuries is that low-velocity missile results in less damage in contrast to the high-velocity missile that causes extensive damage by cavitation and the rapid transfer of kinetic energy into surrounding tissue.…”