The Relationship Between Mechanisms of Wounding and Principles of Treatment of Missile Wounds

Mendelson, Janice A.

doi:10.1097/00005373-199109000-00001

Cited by 50 publications

(26 citation statements)

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“…It has even been postulated that damage can become proportional to even higher powers of velocity when the missile's velocity exceeds the speed of sound in tissue (4760 feet/second) 23,126,134 However, this has been refuted in a more recent experiment. 55 Although the important role of velocity is supported by many studies, 24,39,97,98,104,121,122,133,137,143,152 simply using this formula to predict expected wound damage and therefore one's surgical treatment plan is a serious pitfall.…”

Section: The Overemphasis Of Velocity and The Myth Of The High-velocimentioning

confidence: 99%

“…130 On the other hand, various reports have shown that military rifle bullets potentially can cause no greater tissue disruption than that found in wounds created by low-velocity projectiles. 40,41,44,45,49,51,77,104 There is no doubt that after impact by a high-velocity, rapidly decelerating, deforming, and disintegrating projectile, tissue destruction may extend up to several centimeters radially from the tract, but much of this can be ascribed to factors more important than velocity (see The "Real" Determinants of Wounding). 134 Because of the present overemphasis on velocity, the high velocity bullet has assumed a reputation that is perhaps overstated, which has lead to widespread dogma that these projectiles cause wounds that must be treated by extensive excision of tissue around the missile path ("radical debridement").…”

Section: The Overemphasis Of Velocity and The Myth Of The High-velocimentioning

confidence: 99%

“…Later, several reports from World War II and the Vietnam war, showed that antibiotics alone prevented infection in wounds that received no other treatment for hours to days after injury. 39,41,104,105 Bruised and contused muscle can recover completely as evidenced by the observation a week after injury that some uncomplicated high-velocity wounds have only a microscopic zone of necrosis. 104,105 In a recent study, five pigs had formal surgical debridement with excision of necrotic muscle after injury by brass bullets fired from an M-16, whereas a similarly injured group of five pigs were examined, found to have adequate "decompression and drainage [of the wound]," and treated nonoperatively.…”

Section: The Overemphasis Of Velocity and The Myth Of The High-velocimentioning

confidence: 99%

See 2 more Smart Citations

Common Misconceptions and Controversies Regarding Ballistics and Gunshot Wounds

Bartlett¹,

Bissell²

2006

Techniques in Orthopaedics

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Section: The Overemphasis Of Velocity and The Myth Of The High-velocimentioning

confidence: 99%

Section: The Overemphasis Of Velocity and The Myth Of The High-velocimentioning

confidence: 99%

Section: The Overemphasis Of Velocity and The Myth Of The High-velocimentioning

confidence: 99%

See 1 more Smart Citation

Common Misconceptions and Controversies Regarding Ballistics and Gunshot Wounds

Bartlett¹,

Bissell²

2006

Techniques in Orthopaedics

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“…The direct range of damage is energy dependent and may reach a radius of a few centimeters from the primary tract due to deformation of the penetrating projectile [4]. Penetrating projectiles (not exiting) deliver their total contained kinetic energy whereas those perforating (exiting) transfer significantly less kinetic energy [3,15,37,38]. Almost no extra damage, except that of direct injury to the primary tract, if "high-velocity" full-metal jacket heavy military rifle bullets, such as those fired by the AK-47, NATO 7.62-mm (American version), or the Israeli Galil rifles [14,[39][40][41][42][43] travels only in the soft tissue of an adult human thigh and there is almost little or no difference between the wounding effects of a lowvelocity bullets [13].…”

Section: Bullet and Projectile Ballisticsmentioning

confidence: 99%

Wound Ballistics and Tissue Damage

Rozen

Dudkiewicz

2011

Armed Conflict Injuries to the Extremities

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With globally increasing war, conflicts and terrorism acts, blast or bullet limb injuries are seen more often and present a surgical challenge.The amount of tissue damage and the injury severity of gunshot injuries are due to the energy transmitted by the bullets or projectiles, depending mainly on their velocity. Therefore, the injuries are not divided any more, as in the past, to "high-and low-velocity injury" but to "a high-or low-energy injury."Blast injuries are also energy related and mainly dependent upon the distance from the blast, the energy released from the bombing device, the media (air or water) and the environment in which the blast takes place (close or open). Although the injury may look superficial, it might be much worse and the external wound is sometimes only the tip of the iceberg. Bullet and Projectile BallisticsProjectile or bullet injuries may be classified as "lowenergy" or "high-energy," which describe the amount of damage to the tissues. The factor that most affects the injury severity is the amount and the efficiency of energy transfer [1][2][3][4][5], which is mostly related to kinetic energy that is presented by the equation2 ] (M -mass; V -velocity)" in a bullet that does not "waste" energy on deforming. Other suggested theories are the momentum theory expressed as "Mass × Velocity" and the power theory related to "Mass × Velocity 3 " [6]. Ballistic wounds can be classified, according to the amount of energy causing them, into: high energy (>1,000 J); medium energy (250-1,000 J); low energy (<250 J) [7]. For example, this is the basic principle of successful open fracture classification system as described by GustiloAnderson [8,9].The energy importance is represented by most shot wound classifications, such as the Red Cross classification for war injury [10] that emphasizes wound severity in terms of tissue damage and injuries to specific anatomic structures. The injury is rated according to the size of the entry and exit wounds. It also categorizes the presence of a cavity, a fracture, or an injured vital structure and the presence or absence of metallic bodies [10]. The modified Red Cross classification for civilian injuries, [11] which incorporates the ballistic and clinical aspects of gunshot injuries in civilians, is based on energy dissipation, vital structures injured, type of wound created, severity of bony injury, degree of contamination, and the modified Gustilo-Anderson open fracture classification system in which lowvelocity gunshot wounds are designated as Grade I or Grade II, based on the size of the skin wound and highvelocity gunshot injuries are designated as Grade III injuries, regardless of wound size [12].The cascade of a shot starts with pulling the trigger. This leads to the quick expansion of gas that may reach a temperature of over 2,800°C. This produces

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“…Die Ära der Antiobiotika begann während des Zweiten Weltkrieges [8,58]. Mit dem unkontrollierten Gebrauch von Antibiotika während des Vietnamkriegs kam es erstmals zu einer Zunahme von Infektionen mit multiresistenten Erregern.…”

Section: Hochgeschwindigkeitsgeschosseunclassified

Behandlung von Schussverletzungen des Bewegungsapparates

et al. 2002

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In the view of efficiency and cost effectiveness the increasing incidence of gunshot wounds in Europe demands a modification of treatment protocols. The general basis are debridement of soft tissue injuries, antibiotics and fracture stabilization. The pathology of gunshot wounds and established treatment algorhithms, however have to be adjusted to the ongoing development of gun technology and the thereby caused specific lesions. The treatment of injuries caused by high velocity projectiles necessitates a proactive surgical strategy. Small caliber gunshot wounds can be treated more conservatively. The following review presents an overview on the ballistic and surgical basis for the treatment of gunshot wounds of the musculoskeletal system.

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The Relationship Between Mechanisms of Wounding and Principles of Treatment of Missile Wounds

Cited by 50 publications

References 0 publications

Common Misconceptions and Controversies Regarding Ballistics and Gunshot Wounds

Common Misconceptions and Controversies Regarding Ballistics and Gunshot Wounds

Wound Ballistics and Tissue Damage

Behandlung von Schussverletzungen des Bewegungsapparates

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