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Mon Sep 1 12:45:12 BST 2008

The problem with "shrapnel" nowadays is that it isn't. Shrapnel refers to a specific weapon (ie an exploding shell) whereas most of what is being called shrapnel really are secondary projectiles from a blast, and whatever was between the victim and the blast.

Your standard street bullet is generally lead with some hardening agents while military rounds are jacketed with a combination of copper and zinc. Of these materials, retained lead is encapsulated and, except when in a fluid environment such as a joint, usually remains inert-- although there are multiple reports of lead toxicity due to retained bullet fragments in the literature. Copper, on the other hand, uniformly produces an intense inflammatory reaction resulting in a sterile abscess which matures at about a month and from that point seems to remain stable. In some tissues this can lead to migration, Neurosurgeons and ophthalmologists routinely try to remove retained copper.

Wigle RL: The reaction of copper and other projectile metals in body tissues. J Trauma 1992; 33:1 14-18

Ledgerwood, AM. The wandering bullet. Surg Clin N Amer. 1977;57:97-109

Bland EF, Beebe GW. Missles in the heart: A twenty year follow-up report of World War II cases. NEJM. 1966;274:1039-1046

Messer HD, Cerza PF. Copper jacketed bullets in the central nervous system. Neuroradiology. 1976;12:121-129.

Bogedain W. Migration of schrapnel from lung to bronchus. JAMA. 1984;251:1862-1863

R Wigle MD FACS
Dept Surgery LSUS

--- On Sun, 8/31/08, Christos Giannou <x.giannou at gmail.com> wrote:

> From: Christos Giannou <x.giannou at gmail.com>
> Subject: Re: Projectile composition
> To: trauma-list at trauma.org
> Date: Sunday, August 31, 2008, 8:22 AM
> Projectile composition
> 
> 
> Not much to add to what Tim Hardcastle has to say. Here are
> several articles
> that may help.
> 
> 
> Rhee JM, Marin R. The management of retained bullets in the
> limbs.
> *Injury*1997;
> *28*: 23-38.
> 
> 
> Rich NM, Collins GJ, Andersen CA, McDonald PT, Kozloff L,
> Ricotta JJ.
> Missile emboli. *J Trauma* 1978: *18*: 236-239.
> 
> 
> Linden MA, Manton WI, Stewart RM, Thal ER, Feit H. Lead
> poisoning from
> retained bullets: Pathogenesis, diagnosis, and management.
> *Ann Surgery*1982;
> *195*: 305-313.
> chris giannou
> 
> >
> > ---------- Forwarded message ----------
> > From: Mike Smertka <medic0947969 at yahoo.com>
> > To: Trauma & Critical Care mailing list
> <trauma-list at trauma.org>
> > Date: Sat, 30 Aug 2008 13:55:07 -0700 (PDT)
> > Subject: question about projectile composition
> >
> >
> >
> > Hello again all, In the news today I saw that the army
> is studying the
> > longterm effects of shrapnel left in the bodies of
> soldiers. It made me
> > think of all the GSW fragments I have seen left in
> patients over the years.
> > The standard missile composition I understand to be
> copper jacketed lead.
> > Also common hollow point and softpoint projectiles
> have no covering at all.
> > Does anyone know of the longterm health effects of
> tihs either in civillian
> > studies or anecdotes? What about projectiles with
> tungsten? Does location in
> > the body have an effect on outcome? Look forward to
> the input from the
> > list. thanks again,Mike
> >
> >
> >
> >
> >
> > ---------- Forwarded message ----------
> > From: "Dr Timothy Hardcastle"
> <dr.tchardcastle at absamail.co.za>
> > To: "Trauma &amp; Critical Care mailing
> list" <trauma-list at trauma.org>
> > Date: Sun, 31 Aug 2008 06:25:16 +0200 (SAST)
> > Subject: Re: question about projectile composition
> > Mke
> >
> > No hard published data, but my experience ove the
> years has been that if
> > the bullet is in the soft tissue it undergoes a
> foreign body encapsulation
> > and this is faily benign. Where there may be a problem
>  is where there is
> > contact with either CSF, intraoccular fluid or joint
> space fluid as here
> > electrolysis can occur with lead or copper poisoning.
> >
> > See the bit on the main trauma.org site about bullet
> removal - this should
> > help you too.
> >
> > Tim
> > Dr T C Hardcastle
> > M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
> > Principal Specialist Trauma Surgeon /
> > Honorary Lecturer UKZN Dept Surgery
> > Deputy Director - IALCH Trauma Service
> > >
> 
> 
> 
> 
> -- 
> christos giannou
> Monemvasia Lakonia
> 23070 Greece
> tel & fax: (++30) 27320-61772
> mob: (++30) 69 74 83 28 18
> --
> trauma-list : TRAUMA.ORG
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Projectile composition