Abstract
BackgroundCurrent literature has shown the mechanism of how indirect fractures occur but has not determined what factors increase the risks of such fractures. The objective of this study is thus to determine the effect of clothing and soft tissue thickness on the risk of indirect fracture formation.MethodsTwenty-five fresh red deer femora embedded in ballistic gelatine were shot with varying distances off their medial cortex with a 5.56 × 45 mm North Atlantic Treaty Organization (NATO) bullet while being filmed with a slow-motion video. We compared the effect of two different gelatine depths and the effect of denim cloth laid onto the impact surface of the moulds.ResultsBullet passage in thinner moulds failed to cause fracture because the bullet exited the mould before a large expanding temporary cavity was produced. Clothing dramatically altered the size and depth of the expanding cavity, as well as increased lateral pressures, resulting in more severe fractures with greater bullet distances from the bone that can cause fracture.ConclusionsClothing increases the risk of indirect fracture and results in larger, more superficial temporary cavities, with greater lateral pressures than are seen in unclothed specimens, resulting in more comminuted fractures. Greater tissue depth affords the 5.56 × 45 mm NATO a chance to yaw and thus develop an enlarging temporary cavity that is sufficient to cause fracture.
Highlights
Current literature has shown the mechanism of how indirect fractures occur but has not determined what factors increase the risks of such fractures
It has been shown that the expansion of the temporary cavity causes fractures in near-miss gunshot trauma, where the bullet traverses the soft tissues but never contacts the bone directly [10]
Ballistic gelatine (20%) was utilised because of its similarity to the human muscle and it is often quoted as the standard North Atlantic Treaty Organization (NATO) concentration [22,23]
Summary
Current literature has shown the mechanism of how indirect fractures occur but has not determined what factors increase the risks of such fractures. The objective of this study is to determine the effect of clothing and soft tissue thickness on the risk of indirect fracture formation. Gunshot injuries continue to be a major cause of death and morbidity worldwide with over 500,000 people killed each year and more than 1.5 million injured [1]. This injury principally affects a younger working population in both the military and civilian populations [2,3]. It has been shown that the expansion of the temporary cavity causes fractures in near-miss gunshot trauma, where the bullet traverses the soft tissues but never contacts the bone directly [10]
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