medigraphic.com

2011, Number 1

Cir Gen 2011; 33 (1)

Basic ballistics concepts for the general surgeon and their application in the evaluation of abdominal trauma

Magaña SIJ, Torres SJJ, García-Núñez LM, Núñez-Cantú

Language: Español
References: 22
Page: 48-53
PDF size: 287.83 Kb.


ABSTRACT

Objective: To provide basic ballistic concepts to the General Surgeons that will allow him/her to analyze and assess adequately the intensity of the injuries that might be encountered in a patient with gunshot wounds.
Setting: Central Military Hospital, National Defense Ministry, Mexico City.
Design: Review of the literature.
Material and methods: We analyzed the definitions and concepts of internal, external, and terminal ballistics or of the effects and factors that affect the behavior of a bullet during its trajectory, which will, in consequence, modify its effects on body tissues.
Results: Kinetic energy, which corresponds to the energy released, is given by the product of mass (weight and size of the bullet) by its velocity to the square and divided by two; hence, the greater the size of a bullet, the greater will be the released energy (a bullet twice more mass than another will release twice the energy) and at a higher velocity, higher energy (a two-fold velocity increases four-times the released energy). The factors that affect the behavior of a bullet during its trajectory and that will, in consequence, modify its effects on body tissues are: velocity, profile, stability, expansion and/or fragmentation potential, and the presence of secondary impacts. Velocity is probably the most important factor in the evaluation of a gunshot wound, as this determines the trajectory of the bullet, the greater the velocity, trajectory will be straighter and if the distance is short the bullet will keep practically all its energy. Bullets are not sterile, hence it is very important to consider as contaminated any gunshot wound and to start immediately an appropriate antibiotics scheme. The only valid indications to extract a bullet would be when they are placed intracardially, intra-joints or very near to a joint and/or an important vessel.
Conclusion: The factors to be taken into acount by a surgeon to assess the potential tissular damage in cases of gunshot wounds are: type of firearm, distance at which the shot was made, the surgeon must attempt to know the site of the impact by determining the entrance orifice and the position of the victim at the time of receiving the shot. As additional factors, the number of shots must be known. In the presence of an injury, the surgeon must determine its severity by knowing the physical characteristics of the diverse tissues and their resistance to the damage.

References

  1. Ruiz-Speare O. Balística. En: Ruiz-Speare O. Heridas por proyectil de arma de fuego. México D.F. Editorial Alfil, 2007: 21-33.

  2. Leppäniemi A. Global trends in trauma. Trauma 2004; 6: 193-203.

  3. MacKenzie E, Fowler C. Epidemiology. In: Moore E, Feliciano D, Mattox K. Trauma. 5th edition, McGraw-Hill Medical Publishing Division, United States 2004: 21-39.

  4. Bartlett CS, Helfet DL, Hausman MR, Strauss E. Ballistics and gunshot wounds: effects on musculoskeletal tissues. J Am Acad Orthop Surg 2000; 8(1): 21-36.

  5. Ordog GJ, Wasserberger J. Balasubramaniam S Shotgun wound ballistics. J Trauma 1988; 28(5): 624-631.

  6. Santucci RA, Chang YJ. Ballistics for physicians: myths about wound ballistics and gunshot injuries. J Urol 2004; 171: 1408-1414.

  7. Fackler ML. Gunshot wound review. Ann Emerg Med 1996; 28: 194-203.

  8. Volgas DA, Stannard JP, Alonso JE. Ballistics: a primer for the surgeon. Injury 2005; 36: 373-9.

  9. Simpson BM, Grant RE. A synopsis of urban firearm ballistics: Washington, DC model. Clin Orthop Relat Res 2003; (408): 12-16.

  10. Walker ML, Poindexter JM Jr, Stovall I. Principles of management of shotgun wounds. Surg Gynecol Obstet 1990; 170: 97-105.

  11. Parks WH. Shotgun wound ballistics. J Trauma 1989; 29: 272.

  12. Manzano-Trovamala FJR, Guerrero MMG, Arcaute VF. Balística: Balística de efectos o balística de las heridas. Cir Gen 2001; 23(4): 266-272.

  13. Verleisdonk EJ. Gunshot wounds, firearms and wound ballistics. Ned Tijdschr Geneeskd 2002; 146: 1271-1275.

  14. Hollerman JJ, Fackler ML, Coldwell DM, Ben-Menachem Y. Gunshot wounds: 1. Bullets, ballistics, and mechanisms of injury. AJR Am J Roentgenol 1990; 155: 685-690.

  15. Fackler ML. Ballistic injury. Ann Emerg Med 1986; 15: 1451-1455.

  16. Peters CE, Sebourn CL, Crowder HL. Wound ballistics of unstable projectiles. Part I: projectile yaw growth and retardation. J Trauma 1996; 40(3 Suppl): S10-15.

  17. Von See C, Stuehmer A, Gellrich NC, Blum KS, Bormann KH, Rücker M. Wound ballistics of injuries caused by handguns with different types of projectiles. Mil Med 2009; 174(7): 757-761.

  18. Swift B, Rutty GN. The exploding bullet. J Clin Pathol 2004; 57: 108.

  19. Maiden N. Ballistics reviews: mechanisms of bullet wound trauma. Forensic Sci Med Pathol 2009; 5: 204-209.

  20. Iwata T, Inoue K, Hige M, Yamazaki K, Kawata Y, Suehiro S. Multiple thoracoabdominal gunshot wounds with complicated trajectories. Jpn J Thorac Cardiovasc Surg 2006; 54: 444-447.

  21. Jussila J. Wounding potential of handgun bullets--the relative damage index. Ann Med Milit Fenn 2000; 75: 125-34.

  22. Harcke HT, Levy AD, Getz JM, Robinson SR. MDCT analysis of projectile injury in forensic investigation. AJR Am J Roentgenol 2008; 190: W106-11.

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