Ballistics

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WOW!  You certainly baited the hook after opening the can!  Great summary, Christos!  Thank you. 

Best wishes 
Ron 

Sent from my iPhone

On Jun 13, 2012, at 4:24 AM, "Christos Giannou" <x.giannou at gmail.com> wrote:

> Sorry if I opened a can of worms. I was simply curious about some of the
> comments made about a particular injury that was being discussed on the
> list. Thereby, my question to Norman.
> 
> I have been a war surgeon with the Red Cross-Red Crescent for over 30
> years. I do not regularly see handgun bullet wounds. AK-47, M-16, landmines
> and various bombs and shells are my meat and potatoes. Much has been
> written about wounds provoked by such weapons in the last few years, for
> obvious reasons, and the reason for the present discussion about the future
> of Landstuhl.
> 
> 
> 
> Briefly:
> 
> 
> 
> "Treat the wound, not the weapon" comes from Lindsey D. The idolatry of
> velocity, or lies, damn lies, and ballistics. *J Trauma* 1980; *20*: 1068 –
> 1069.
> 
> 
> 
> Fackler's 1987 study, although containing much information that is still
> pertinent, has been superseded by other work, as Norman mentioned.
> 
> 
> If I may quote myself: Although the study of ballistics may be
> “interesting” in its own right, the clinician does not always know what
> weapon inflicted the injury; and *never *knows the energy available at
> point of impact. One can only estimate the transfer of energy in the
> tissues from the extent of tissue damage. The study of ballistics gives us
> an understanding of the basic mechanisms at work during wounding. The
> importance of this knowledge lies in the fact that projectile injuries
> should be neither under- nor over-treated. (*War Surgery: Working with
> limited resources. Volume 1* Geneva: ICRC; 2009.)
> 
> 
> 
> I think that this is the exact point that Norman was making. An
> understanding of wound ballistics helps in understanding the pathology that
> the surgeon sees.
> 
> 
> 
> Is this clinically important?
> 
> 
> 
> I offer just one example from the recent literature: Tien HC, van der Hurk
> TWG, Dunlop MP, Kropelin B, Nahouraii R, Battad AB, van Egmond T. Small
> bowel injury from a tangential gunshot wound without peritoneal
> penetration: a case report. *J Trauma* 2007; *62*: 762 – 764. (in
> attachment)
> 
> 
> 
> If you read this article, you will find that: "The patient did have small
> bullet fragments in the left flank area, likely corresponding to the bullet
> track. …trauma room ultrasound showed no fluid …It was thought that he had
> a tangential gunshot wound to the left flank with no peritoneal
> penetration. However, since we did not have CT or laparoscopic capability
> at the time, the patient was taken to the operating room for an exploratory
> laparotomy." At laparotomy, a full-thickness lesion was found of the small
> bowel that required excision and repair.
> 
> 
> 
> In the ICRC, we regularly operate with plain X-ray films; no CT,
> ultrasound, or any other imaging. An entry-exit wound through a significant
> distance of tissue and showing *fragmentation of the bullet* demands
> exploration even if there is no clinical evidence of peritoneal
> penetration. This type of wound can only be created by a very considerable
> transfer of kinetic energy to the tissues, whatever the weapon. Therefore,
> an understanding of ballistics helps in understanding the pathology and its
> clinical implications. Not always, though. Many, if not most ballistic
> wounds, do not fall into this category. But an understanding of ballistics
> allows me to determine which ones do. Another point that I think was made
> by Norman.
> 
> 
> best regards
> -- 
> christos giannou
> Monemvasia Lakonia
> 23070 Greece
> tel & fax: (++30) 27320-61772
> <Small_Bowel_Injury_From_a_Tangential_Gunshot_Wound.pdf>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/

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