Temporary Cavitation in High-Velocity Pulmonary Missile Injury

Amato, Joseph J.; Billy, Lawrence J.; Gruber, Ronald P.; Rich, Norman M.

doi:10.1016/s0003-4975(10)64402-5

Cited by 13 publications

(4 citation statements)

References 9 publications

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“…Flash X-ray provided information about projectile yaw but also could have been utilised to collect data on temporary cavitation, as demonstrated in previous studies [15][16][17]19]. This yaw would allow for an increase in the KE delivered to the tissues and likely accounted for the larger and more variable exit wounds seen in this study.…”

Section: Flash X-raymentioning

confidence: 94%

“…The use of flash X-ray allows a snapshot of what happens within opaque tissue during the ballistic event under study. With knowledge of the timing of imaging in relation to the projectile's position within or outside of the model, measurements of temporary cavity dimensions can be captured, as well as evidence of bone fracture, and yaw of the projectile [15][16][17][18][19][20].…”

Section: Flash X-raymentioning

confidence: 99%

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Ballistic research techniques: visualizing gunshot wounding patterns

et al. 2020

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There are difficulties associated with mapping gunshot wound (GSW) patterns within opaque models. Depending on the damage measurement parameters required, there are multiple techniques that can provide methods of "seeing" the GSW pattern within an opaque model. The aim of this paper was to test several of these techniques within a cadaveric animal limb model to determine the most effective. The techniques of interest were flash X-ray, ultrasound, physical dissection, and computed-tomography (CT). Fallow deer hind limbs were chosen for the model with four limbs used for each technique tested. Quarantined 7.62 × 39 mm ammunition was used for each shot, and each limb was only shot once, on an outdoor range with shots impacting at muzzle velocity. Flash X-ray provided evidence of yaw within the limb during the projectile's flight; ultrasound though able to visualise the GSW track, was too subjective and was abandoned; dissection proved too unreliable due to the tissue being cadaveric so also too subjective; and lastly, CT with contrast provided excellent imaging in multiple viewing planes and 3D image reconstruction; this allowed versatile measurement of the GSW pattern to collect dimensions of damage as required. Of the different techniques examined in this study, CT with contrast proved the most effective to allow precise GSW pattern analysis within a cadaveric animal limb model. These findings may be beneficial to others wishing to undertake further ballistic study both within clinical and forensic fields.

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Section: Flash X-raymentioning

confidence: 94%

Section: Flash X-raymentioning

confidence: 99%

Ballistic research techniques: visualizing gunshot wounding patterns

et al. 2020

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“…This results in considerable energy transfer, often with extensive fragmentation of both bone and bullet. There follows the potential for these fragments to be accelerated as secondary missiles [6,7].…”

Section: Bonementioning

confidence: 99%

High velocity gunshot injuries to the extremities: management on and off the battlefield

Penn-Barwell

Brown

Fries

2015

Curr Rev Musculoskelet Med

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The gunshot wounds sustained on the battlefield caused by military ammunition can be different in nature to those usually encountered in the civilian setting. The main difference is that military ammunition has typically higher velocity with therefore greater kinetic energy and consequently potential to destroy tissue. The surgical priorities in the management of gunshot wounds are hemorrhage control, preventing infection, and reconstruction. The extent to which a gunshot wound needs to be surgically explored can be difficult to determine and depends on the likely amount of tissue destruction and the delay between wounding and initial surgical treatment. Factors associated with greater energy transfer, e.g., bullet fragmentation and bony fractures, are predictors of increased wound severity and therefore a requirement for more surgical exploration and likely debridement. Gunshot wounds should never be closed primarily; the full range of reconstruction from secondary intention to free tissue transfer may be required.

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“…[5][6][7][8] This phenomenon has been shown in both the neurosurgical and orthopedic literature. [9][10][11][12][13] Small entry wounds from a fragment are deceptive, as they could be associated with extensive internal injury and do not always follow a straight line.…”

mentioning

confidence: 99%

Unexpected multiple intra-abdominal injuries after projectile fragmentation: report of three cases

Ünlü

Petrone²,

Karsidag

et al. 2012

Ulus Travma Acil Cerrahi Derg

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Patlayıcılar, daha fazla parçalanmaya eğilimli veya vücut içinde daha başka mermiler oluşturan parçacıklar yaratıp onlara enerji yüklerler. Bu parçacıklar ikincil yaralanmalara yol açabilirler. Bu durum ortopedi ve nöroşirürji literatüründe tekrar tekrar anlatılmıştır. Biz, askeri ortamda fasyayı deldikten sonra oluşan karın yaralanmaları için de aynı süreci raporlamaktayız. Bu bir gözlemsel olgu serisi çalışmasıdır. Karın duvarı yaralanmalarına maruz kalmış bilinci açık hastalarda standart yaklaşım olarak lokal yara eksplorasyonu uygulandı. Fiziksel inceleme sonuçları negatif hastalar çalışmadan çıkartıldı. Tam kat fasya defekti olanlarda periton içi yaralanma olduğu varsayılarak laparotomi uygulandı. Yirmi hasta çalışmaya uygunluk kriterlerini karşılamıştı. Bu 20 hastanın 12'sinde yara eksplorasyonunda anormal sonuç çıkmadı, sekiz (%40) hastada abdominal organ yaralanmaları saptandı. Laparotomi sı-rasında bu hastaların üçünde (%38) mermi yaralanmaları dağınık bir dağılım sergiledi. Bu yaralanmalar öngörülen mermi yolundan uzakta olup kemik parçalanmamıştı. Perforan yaralanmalar dışlandığında genelde ortalama periton defekti sayısı 1.7 olup her bir periton defekti için ortalama 6.8 karın içi yaralanma mevcuttu. Tek bir periton defektine rağmen merminin parça tesirli olması nedeniyle birden çok sayıda periton içi yaralanma oluşabilmektedir. Kitlesel yaralanmalarda tam kat fasya defektiyle yara eksplorasyonu olası karın içi yaralanmaların bir göstergesi olarak işlev gördüğü gibi sonuçta eksploratuvar laparotomiyi gerektirir.Anahtar Sözcükler: Karın; patlayıcı; penetran yaralanmalar; mermi; fragmantasyon.Explosives create and energize particles that act as projectiles prone to further fragmentation or create other secondary missiles in the body. These fragments may result in secondary injuries. This has been repeatedly described in the orthopedic and neurosurgical literature. We report the same process for abdominal injuries after fascial penetration in the military setting. This is an observational case series study. Local wound exploration as a standard approach was performed in conscious patients who sustained abdominal wall injuries. Patients with negative physical examination were excluded from the study. An intraperitoneal injury was assumed in those with a full-thickness fascial defect, and laparotomy was performed. Twenty patients met the study eligibility criteria. Of those 20 patients, 12 had negative wound exploration and were excluded from the study, while abdominal organ injuries were found in eight (40%) patients. During laparotomy, projectile-induced injuries in a sprayed distribution were found in three (38%) of these patients. These injuries were far from the predictable trajectory and in the absence of bone fragmentation. The overall mean number of peritoneal defects was 1.7, and a mean 6.8 intra-abdominal injuries for each peritoneal defect were found when through-and-through injuries were excluded. Despite a single peritoneal defect, there may be multiple intraperitoneal injuries due to further...

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Temporary Cavitation in High-Velocity Pulmonary Missile Injury

Cited by 13 publications

References 9 publications

Ballistic research techniques: visualizing gunshot wounding patterns

Ballistic research techniques: visualizing gunshot wounding patterns

High velocity gunshot injuries to the extremities: management on and off the battlefield

Unexpected multiple intra-abdominal injuries after projectile fragmentation: report of three cases

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