Ballistic Injuries Research Articles

198 - Ballistic injury to neck causing possible thyroid storm

198 - Ballistic injury to neck causing possible thyroid storm

Description of the Public Safety Medical Response and Patient Encounters Within and During the Indianapolis (USA) Spring 2020 Civil Unrest.

This study describes the local Emergency Medical Services (EMS) response and patient encounters corresponding to the civil unrest occurring over a four-day period in Spring 2020 in Indianapolis, Indiana (USA). This study describes the non-conventional EMS response to civil unrest. The study included patients encountered by EMS in the area of the civil unrest occurring in Indianapolis, Indiana from May 29 through June 1, 2020. The area of civil unrest defined by Indianapolis Metropolitan Police Department covered 15 blocks by 12 blocks (roughly 4.0 square miles) and included central Indianapolis. The study analyzed records and collected demographics, scene times, interventions, dispositions, EMS clinician narratives, transport destinations, and hospital course with outcomes from receiving hospitals for patients extracted from the area of civil unrest by EMS. Twenty-nine patients were included with ages ranging from two to sixty-eight years. In total, EMS transported 72.4% (21 of 29) of the patients, with the remainder declining transport. Ballistic injuries from gun violence accounted for 10.3% (3 of 29) of injuries. Two additional fatalities from penetrating trauma occurred among patients without EMS contact within and during the civil unrest. Conditions not involving trauma occurred in 37.9% (11 of 29). Among transported patients, 33.3% (7 of 21) were admitted to the hospital and there was one fatality. While most EMS transports did not result in hospitalization, it is important to note that the majority of EMS calls did result in a transport. There was a substantial amount of non-traumatic patient encounters. Trauma in many of the encounters was relatively severe, and the findings imply the need for rapid extraction methods from dangerous areas to facilitate timely in-hospital stabilization.

Maxillofacial Surgery inUkraine During a War: Challenges andPerspectives-A National Survey.

The invasion of Ukraine by Russian troops on February 24, 2022, and the beginning of the full-scale war had huge humanitarian consequences. The major challenges facing the Ukrainian health care system included the disruption of medical infrastructure and logistics, the termination of the supply of expendable materials, significant migration, and a dramatic increase in high-velocity blast and gunshot injuries among combatants and civilians.The aim of the present study was to analyze the challenges and solutions in patient care faced by the Ukrainian system of maxillofacial surgery during the war in different regions of the country. A cross-sectional study was designed and implemented as an online survey to collect national data concerning maxillofacial surgeons' experiences and professional activities. The study was initiated and supported by Bogomolets National Medical University (Kyiv, Ukraine), the Ukrainian representative of AO CMF (Arbeitsgemeinschaft für Osteosynthesefragen Craniomaxillofacial Surgery) and the University of Helsinki (Finland).The questionnaire was developed by specialists in maxillofacial surgery and sociologists and contained 65 close-ended questions. Surgeons who had not worked in this specialty in inpatient departments of hospitals since at least the beginning of the full-scale war were excluded from the study. We received and analyzed 97 responses that met the abovementioned criteria. The geography of respondents covered all the regions and the main cities of Ukraine, expect for the occupied territories. After a year of warfare, the percentage of surgeons who treated patients with blast and gunshot injuries increased from 43.4% to 86.6%. This percentage was higher in military hospitals and in regions located in the vicinity of the front line. We found that, during the war, 78.6% of respondents performed osteosynthesis in cases of high-velocity multifragmented facial bone fractures (in such cases, 58.3% of them strictly followed AO CMF recommendations, while 41.7% performed the fixation based on available hardware, existing technical possibilities and their own preferences). We found that 70.2% of respondents had the opportunity to apply Computer-Aided Design/Computer-Aided Manufacture technology and patient-specific implants for the treatment of gunshot injuries, 38.1% reported that their hospitals were able to perform microsurgical reconstructions for facial defects, 79.4% of respondents reported that their departments received humanitarian aid and support from volunteer organizations (either Ukrainian or international), which significantly facilitated the treatment process. According to this nationwide survey of Ukrainian maxillofacial surgeons during a year of the full-scale war, 86.6% of respondents were involved in the treatment of gunshot and ballistic injuries in civilians and combatants. The main problems reported by the respondents were (1) a lack of experience and knowledge related to the treatment of severe wounds, especially by secondary reconstruction, and (2) a deficit of resources (equipment, materials, and medications) under conditions of disrupted logistics and changes in the numbers and nosological distribution of patients. There were the opportunity to transfer the patients to European clinics (29.9%), online consultations (45.4%), collaboration with foreign surgeons who come to Ukraine asvolunteers (32%).

Morphological Features of Wound Canals and Intracranial Pathology in Non-Penetrating Gunshot Craniocerebral Injuries

Background. Non-penetrating craniocerebral trauma in modern warfare, according to our data, accounts for up to a fifth of all gunshot wounds of the skull and brain in armed conflicts at the end of the last century and the beginning of the current century. It is a complex problem of military field surgery, first of all from the point of view of solving an important task of the medical services of the warring parties – restoring the maximum number of wounded. The study of pathomorphological wound channels in various types of gunshot non-penetrating craniocerebral injuries gives opportunities for the development of adequate options for access during surgical treatment. 
 Object: to reveal the morphological features of wound canals and internal cranial injuries in gunshot non-penetrating craniocerebral injuries for optimal planning the primary surgical treatment of the wound.
 Material and Methods. Study and analysis of morphological features of wound canals and intracranial pathology in 155 non-penetrating gunshot craniocerebral injuries of the military who underwent surgical treatment in the 2nd and 3rd level healthcare institutions during the war in 2014-2020. The morphology of wound canals and intracranial injuries were studied based on the laws of wound ballistics, clinical data, and computed tomography data.
 Results. The largest proportion of non-penetrating gunshot wounds is perforated and depressed fractures (39.9%); perforated fractures with penetration of a fragment to the inner plate of the bone account for 20% and incomplete (to the bone) make up 5.8%. Among blind non-penetrating wounds, single ones prevail (65.2%). More often, they have a cylindrical blind canal. Subarachnoid hemorrhage, brain congestion, and very rarely epidural hematoma (one case) are found in almost all perforated bone fractures. A more complex pathomorphological structure is present in multiple non-penetrating gunshot wounds. At the same time, only one fragment causes a depressed skull fracture. Large and small wound canals can be distinguished by width. The latter do not damage the bones and do not require surgical treatment. This type of injury is accompanied by a subarachnoid hemorrhage in 78% of cases and by brain congestion near the fracture in 43% of cases. Tangential injuries occur in 21.9% of injuries; they have a grooved elongated shape. The bottom of these wounds are linear and compressed fractures. Rarely, subdural and intracerebral hematomas are formed in the projection of the fracture. All non-penetrating injuries are accompanied by small brain congestion of the I-II degrees and subarachnoid hemorrhage. Epidural and intracerebral hematomas can rarely occur with blind non-penetrating cranial injuries.
 Conclusions. Non-penetrating multiple fragmental injuries are accompanied by the greatest soft tissue damage. In case of blind wound canals, there are incomplete perforated and perforated-depressed skull fractures; linear and depressed fractures occur in tangential canals. Regardless of the type of wound canals in the brain, there are small congestions (hemorrhages) and subarachnoid hemorrhage. In rare cases, epidural and intracerebral hematomas are formed. Subdural hematomas, sometimes combined with intracerebral hematomas, are found in tangential non-penetrating wounds. Projectiles in tangential wounds do not cause molecular shock and do not lead to secondary necrosis, therefore, it is not necessary to cut the edges of the wound during the primary surgical treatment.

Primary Free Flaps for Coverage and Reconstruction in Acute Facial Trauma.

Background Acute facial trauma in motor vehicle accident defects may be associated with skeletal, neuromuscular, or mucosal losses. Simultaneous repair of the critical structures in these defects mandates the use of flap cover; paucity of local tissues necessitates the use of free skin flaps. Materials and Methods Six free flap reconstructions for acute facial trauma defects over a 10-year period were reviewed. The defect location, associated injuries, flap choice, additional reconstructive procedures, and flap outcomes were analyzed. Results There were four males and two females with ages between 18 and 63 years. Four defects were located in the lateral face and scalp, and two in the lower central face. Defect size ranged between 96 and 346 cm 2 . There were fractures in three, facial nerve injuries in two, and loss of facial muscles in one. Five free flaps were anterolateral thigh flap; simple and composite, one was a radial artery forearm flap. Recipient pedicles were the superficial temporal vessels in two and facial vessels in four cases. There were no re-explorations but one flap necrosed on 7th postoperative day on account of invasive aspergillosis. Discussion Use of free flaps for ballistic wounds is common. In uncommon nonballistic traumatic facial defects, the location, nature of the defect, and type of associated injuries and need for simultaneous reconstructions may dictate the use of free flaps and permit a one stage debridement, flap coverage, and a simultaneous reconstruction of lost functional units. Conclusion Free flap coverage in high velocity acute facial trauma defects offers a better possibility for primary reconstruction of associated facial injuries and helps in achieving better functional outcomes.

A predictive model of motor deficit in civilian ballistic lumbosacral spine injuries

BACKGROUND CONTEXTCivilian gunshot wounds to the spine are an increasingly common injury in the USA. A majority of the available research is focused on a military population suffering high energy missile injury. Minimal research has focused on civilian ballistic injuries to the lumbosacral spine as the available studies focus on the entire spine due to limited numbers. PURPOSECharacterize ballistic injuries to the lumbosacral spine and develop a model to predict the presence of neurological deficit based upon a patients presenting fracture morphology. STUDY DESIGNRetrospective chart review. PATIENT SAMPLEOne hundred forty-eight consecutive patients that were presented to an urban level 1 trauma center with ballistic injures to the spine involving the levels L1–S2. OUTCOMES MEASURESNeurological status at presentation and final follow up using the American Spinal Injury Association (ASIA) Impairment Scale. METHODSIRB approval was obtained, and retrospective chart review was performed. Extracted data included patient demographics, neurological status on presentation and final follow-up, fracture morphology, assessment of stability, other associated injuries, and surgical procedures performed. Proportional analysis was performed to characterize the fractures and their associated neurological injuries. Chi-square testing was done to identify fracture characteristics associated with neurologic injury. A multiple logistical regression was performed using fracture characteristics highly associated with neurological deficit to develop a model to predict neurologic deficit. The model was then validated with a receiver operator curve. RESULTSOf the 148 patients, 14 patients underwent spinal surgery with the most common indication being decompression and foreign body removal. There was a high incidence of intra-abdominal injury (73.6%). Fractures were characterized by level, affected vertebral component, and spinal canal involvement. Neurological injury was classified using the ASIA scale at presentation and final follow up. Odds-ratios of vertebral fracture characteristics showed neurologic deficit was highly associated with pedicle fractures (OR=9.07 [4.14–21.54] – 95% CI), lamina fractures (OR=6.42 [3.16–13.62] – 95% CI), facet fractures (OR=5.95 [2.90–12.79] – 95% CI), intra-canal bone (OR=12.79 [5.98–29.05] – 95% CI), and an intra-canal trajectory (OR=1078 [4.48–28.98]) – 95% CI. Multiple logistic regression was performed to construct a predictive model of neurologic deficit which showed that intra-canal trajectory, pedicle fracture and facet fracture are associated with neurologic deficit. An ROC curve was made with an area of 0.849 ([0.7853 to 0.9128 – 95% CI], p<.0001) demonstrating a good model fit. CONCLUSIONSBallistic injuries to the lumbosacral spine involve complex injury patterns in an often polytraumatized patient. Fractures involving the pedicle, lamina, and facet are highly associated with neurologic injury, as is a trans-canal trajectory. A patients fracture morphology can be used to predict if a neurologic deficit is present.

Socioeconomic status is associated with greater hazard of post-discharge mortality than race, gender, and ballistic injury mechanism in a young, healthy, orthopedic trauma population

ObjectivesTo explore the utility of legacy demographic factors and ballistic injury mechanism relative to popular markers of socioeconomic status as prognostic indicators of 10-year mortality following hospital discharge in a young, healthy patient population with isolated orthopedic trauma injuries. MethodsA retrospective cohort study was performed to evaluate patients treated at an urban Level I trauma center from January 1, 2003, through December 31, 2016. Current Procedure Terminology (CPT) codes were used to identify upper and lower extremity fracture patients undergoing operative fixation. Exclusion criteria were selected to yield a patient population of isolated extremity trauma in young, otherwise healthy individuals between the ages of 18 and 65 years. Variables collected included injury mechanism, age, race, gender, behavior risk factors, Area Deprivation Index (ADI), and insurance status. The primary outcome was post-discharge mortality, occurring at any point during the study period. ResultsWe identified 2539 patients with operatively treated isolated extremity fractures. The lowest two quartiles of socioeconomic status (SES) were associated with higher hazard of mortality than the highest SES quartile in multivariable analysis (Quartile 3 HR: 2.2, 95% CI: 1.2–4.1, p = 0.01; Quartile 4 HR: 2.2, 95% CI: 1.1–4.3, p = 0.02). Not having private insurance was associated with higher mortality hazard in multivariable analysis (HR 2.0, 95% CI: 1.3–3.2, p = 0.002). The presence of any behavioral risk factor was associated with higher mortality hazard in univariable analysis (HR: 1.8, p < 0.05), but this difference did not reach statistical significance in multivariable analysis (HR: 1.4, 95%: 0.8–2.3, p = 0.20). Injury mechanism (ballistic versus blunt), gender, and race were not associated with increased hazard of mortality (p > 0.20). ConclusionLow SES is associated with a greater hazard of long-term mortality than ballistic injury mechanism, race, gender, and medically diagnosable behavioral risk factors in a young, healthy orthopedic trauma population with isolated extremity injury.

Particularities of ballistic spinal injuries and management in an African context (Chad): Study of 27 cases

The frequency of ballistic spinal injuries is rising in developing nations around the globe. These injuries lead to a functional prognosis linked to disabling sequelae and vitals in patients, which often results in serious complications and death.This study describes the epidemiological, diagnostic, therapeutic, evolutionary characteristics of Ballistic Medullar-Vertebral trauma (BMVT). It presents the particularities of management in the sub-Saharan African country of Chad.This is a prospective descriptive study of 27 ballistic spinal injury patients conducted over an 18-month period.Ballistic Medullar-Vertebral injuries (BMVI) represented 12.9 % of spinal trauma. The average age of the patients was 31.8, and 40.7 % were between 31 and 40 years of age. Military personnel represented 78 % of the patients. 44.4 % of cases came from the Lake Chad region. 59.3 % of injuries were caused by Kalashnikov’s (AK 47) firearms. 74.1 % of cases were admitted to the emergency department within 12 to 24 h. The diameter of the wounds that corresponded to the entry orifice of the bullet was between 1 and 2 cm in 59.25 % of the cases. A Dural breach was found in 14.8 %. 48.1 % had ASIA C score and none of them met the criteria for spinal cord injury collection and immobilization. The lumbosacral location was reported in 55.6 %, and the type I Roy Camille fracture was found in 70.37 %. Surgical management was performed in 88.9 % cases. Multidisciplinary management of the associated lesions was performed in 25.9 %. 7.4 % of patients with cervical trauma died due to septic shock.Delayed emergency department admissions and limited access to medicalized transportation are main factors to BMVI in Chad. Lesion is predominantly located in the lumbosacral region. Lesions and spinal cord involvement were factors of poor vital and functional prognosis. Surgery plays an important role in management. Socio-professional reintegration remains problematic.

Ballistic injuries of the humerus: A matched cohort analysis

Introduction Ballistic fractures of the humerus secondary to gunshot wounds are increasingly common injuries that pose challenges for orthopedic surgeons. The primary purpose of this study was to examine the rates of neurovascular injury, compartment syndrome, and infection of ballistic humerus fractures relative to blunt, non-penetrating fractures. Methods A consecutive cohort of 135 patients with ballistic humerus fractures and 167 patients with blunt humerus fractures treated at a level 1 trauma center were identified. A review of patient medical records and radiographic studies was performed to obtain demographic information, injury mechanism, fracture location, choice of treatment, and complications. Statistical analysis was performed using independent sample t-tests, chi-square tests, and odds ratios ( p &lt; 0.05 significance). Results Compared with blunt fractures, patients in the ballistic fracture cohort were younger, male, African American, test positive for illicit drug use, and sustain proximal fractures. Ballistic fractures had significantly lower Injury Severity Scores and New Injury Severity Scores. Ballistic fractures were three times as likely to present with neurovascular injury than blunt fractures (OR: 2.927, p &lt; 0.001). The overall rate of spontaneous recovery of significant motor function for ballistic fractures with neurologic injury was 55%. There were no statistically significant differences in rates of vascular injury, compartment syndrome, infection, non-union, or the need for soft tissue reconstruction. Conclusion Compared with blunt humeral fractures, ballistic fractures appear to have a significantly higher rate of neurologic injury but no increased risk for compartment syndrome or infection. Surgical treatment of ballistic humeral injuries was not associated with increased neurological recovery compared to non-operatively managed fractures.

Features of damage to the leather substitute when fired from the “FORT 12R” and “AE 790G1” pistols from different distances

Annotation. Examination of damage caused by firearms is always a difficult challenge for a forensic scientist. The reason for this is the unpredictability of the interaction of the trace-receiving surface with the ammunition, additional factors of the shot and residual components of the shot, which in turn is caused by the specific design of different types of firearms and the composition of different types of ammunition, which is also combined with various factors affecting pre-wound ballistics (weather factors, etc.), wound ballistics (different types of human body tissue, different materials of obstacles, their presence, etc.). All these factors require detailed study. The purpose of the study is to compare the features of damage to the leatherette as a complex “clothing + non-biological human body simulator” when shot from different distances using the “Fort 12R” and “AE 790G” pistols. The experimental study was conducted by manufacturing ballistic gelatin blocks, which were covered with leatherette and fired at close range, 25 and 50 cm using “Fort 12R” and “AE 790G1” pistols. The analysis of all fired samples of leatherette revealed the formation of a minus-tissue type defect, with the formation of a round (mostly at close range for both pistols) or oval shape (at 25 and 50 cm for both pistols). Gap formation is characteristic of point-blank shots for both pistols and the Fort 12R at 25 cm. All shot distances and both pistols are characterized by the deposition of residual shot components in the form of half-burnt or unburned powder particles. The dimensions of the defect are approximately the same, but when using Fort 12R, the formation of larger defects was recorded at all shot distances. Thus, during the visual examination, when comparing the samples of leatherette from all the studied distances, significant differences were found between all the studied groups, in particular, between the respective groups of pistols, which makes it possible to identify the pistol already during the visual examination of the sample.

178 Damage Control Surgery in Severe Ballistic Trauma

Abstract Introduction Severe ballistic lesions are the cause of hemodynamic disorders and early coagulopathy causing a high mortality rate, their management needs to be adapted to each situation. Materials &amp; Methods This retrospective study aims to evaluate the feasibility and outcomes of abbreviated laparotomy and early re-exploration. It includes patients suffering from severe ballistic injuries who had to undergo a Damage Control Surgery (DCS) due to a high severity trauma score. Moreover, morbidity and mortality rates were analysed. Results The sample included 73 male patients with an average age of 31years. Most patients suffered from haemorrhagic shock 74%, respiratory distress 40%, and peritoneal contamination 63%. The severity score was 64. After (DCS), the re-exploration was impossible in certain cases. The mortality rate was 28, 8%. Conclusion Abbreviated laparotomy and DCS are effective practices for stabilizing victims of gunshot and maintaining the function and integrity of the organism.

Semi-computational approach for assessing the damage to human soft tissues: the case of FMJRN versus HP-XTP 9mm bullet penetration in ballistic soap.

Ballistic soap blocks are used in wound ballistics to assess the potential damage of the ammunition employed, allowing observation of the energy transfer occurred along the wound channel. The density and viscosity of ballistic soap (also called tissue simulant) simulate, to a good degree of approximation, the effect resulting from the interaction of penetrating bullets withliving human soft tissue. Ballistic soap has a "plastic reaction" to bullet penetration, and therefore, unlike ballistic gelatin, the expansion of temporary cavityremains imprinted in the tissue simulant. When the soap blocks are sectioned or divided withnondestructive instrumental techniques (e.g., Compton's scattering tomography), it's possible, therefore, to observe the temporary cavity determined by the penetration of the bullet. This study provides insight into the severity of injuries originatedfrom two different types of bullets of the same caliber by employing ballistic soap as a tissue simulant. In addition, it provides guidance to forensic practitioners on the proper use of ballistic soap for simulating gunshot wounds. The semi-computational approach employed, based on the results obtained from the firing tests, allowed the authors to understand that there is likely a threshold value of projectile energy density, close to 1J/mm2, beyond which its penetration into the ballistic soap ceases.

Audiologic Consequences of Gunshot Wounds to the Temporal Bone Show No Relation to Concomitant Neurologic or Vascular Injuries.

To evaluate audiologic consequences of gunshot wounds (GSWs) to the temporal bone (TB), and to correlate hearing outcomes with neurologic and vascular injuries adjacent to the temporal bone. Retrospective case series. University-based level-one trauma center. Retrospective review of 35 patients surviving TB ballistic injury, 2012 to 2021. Main outcomes were audiologic results. Demographics, concomitant injuries, CT, and interventions were reviewed. Mean age was 30.7 years; 80% male. Seventeen patients (48.6%) underwent audiologic testing. Mean pure tone average (PTA) was 75 ± 35 dB, bone line average 41 ± 26 dB, and speech discrimination score (SDS) 60 ± 43%. Nineteen (54.3%) demonstrated facial nerve injury (FNI), who were more likely to show SNHL especially anacusis, though their mean PTA and SDS were not statistically different from those without (P = .30 and .47, respectively). Radiographic review of those with sensorineural loss (SNHL, 6/17) revealed otic capsule-disrupting fracture (n = 2), pneumolabyrinth (n = 2), intracranial hemorrhage (n = 3). Those with mixed loss (6/17) showed otic capsule-sparing fracture (n = 6), EAC injury (n = 5), ossicular discontinuity (n = 2), and intracranial hemorrhage (n = 4). Two with mastoid tip fractures alone had normal audiograms. Audiometric outcomes were not predicted by concomitant CSF leak, spinal injuries, vascular injuries, cranial neuropathies, or traumatic brain injury. All patterns of hearing loss-conductive, sensorineural, mixed and normal-may be seen following TB ballistic injuries. Trauma severe enough to disrupt the facial nerve is more likely to cause anacusis. However, all should be formally evaluated, since ballistic injuries complicated by neurologic or vascular damage do not necessarily correlate with worse audiologic outcomes, while patients with minimal fractures may demonstrate losses.

A novel clinico-surgical algorithm for management of maxillofacial gunshot wound injuries

Ballistic injuries commonly called gunshot wound injuries (GSWI) can be catastrophic in the head and neck regions. The degree of destruction correlates with the range and type of the weapon and projectile speed. The intricacies of the facial anatomy makes the reconstructive phase a challenge. The dilemma lies in decision-making of immediate (single stage) or delayed (multiple stage) reconstruction of hard and soft tissues. In this article we highlight a novel clinico-surgical algorithm for managing gunshot wound injuries.

Vacuum-therapy in the complex treatment of gunshot wounds: current aspects and prospects (review)

Abstract. Nowadays an effective treatment of gunshot wounds is an extremely urgent problem of the health care system. Ballistic injuries occupy a leading position in the structure of combat wounds. Moreover, they are associated with purulent-infectious complications, disability, which causes a long-time healing and rehabilitation of the patients. The vacuum-therapy method is used in clinical practice for reducing the frequency and severity of complications and cuttingthe wound process’s stages duration. At the same time, there is no consensus in the scientific community regarding the feasibility of vacuum therapy application for this type of injuries. The aim of our study was to analyze scientific literature data regarding the feasibility of vacuum therapy using in the complex treatment of gunshot wounds. Materials and methods. Open sources of scientific literature were processed, in particular, but not exclusively, the results of clinical studies, data from several studies to summarize and analyze information aboutvacuum therapy effect on cytological, biochemical, hematological, morphological and other parameters in patients with gunshot wounds. Results and discussion. The data of studied papers indicate that the vacuum-associated therapy method’sapplication allows almost two times accelerationof granulation tissue formation, more effective wound cleaning from necrotic tissues and microbial contamination, thereby significantly reducing of healing period duration. The mechanisms of these effects realization are multifactorial and include reduction of edema and exudate amount, normalization of local blood flow, change of local expression of growth factors related to angiogenesis, etc. Conclusions. Based on the data presented in the scientific literature, it is possible to conclude that vacuum therapy has a significant positive effect on the course of the wound process, compared to traditional schemes for gunshot wounds therapy, which reduced the frequency of complications and allowed to cut convalescence period in patients with gunshot wounds.

Ballistic injury to the neck in a soldier injured in the war in Ukraine

Introduction and relevance: Penetrating neck trauma results in a 10% mortality rate for patients and management can be challenging, often requiring a multidisciplinary approach.Methods: This is a case report of a 33-year-old male patient who received a neck gunshot through the oral cavity during close combat on the south front of the Ukrainian-Russian war in January 2023.Clinical discussion: A CT scan revealed a foreign body in the neck on the right side, between the mastoid process and the right jaw angle. A CT scan with contrast revealed a foreign body in the neck – a bullet – and helped with observing relations to surrounding tissues and following the bullet’s trajectory. The multidisciplinary team performed surgery for foreign body removal. As a first step, carotid arteries and the internal jugular vein were dissected and looped to control potential bleeding. The bullet was 7.62 caliber. The patient recovered well with minimal postoperative complications, including hypoglossal and facial nerve neuropathy, which resolved in two weeks.Conclusion: The proximity gunshot resulted in unexpectedly moderate tissue injury, but regardless of the relatively low destruction of palate tissue, the location of the foreign body near carotid arteries made the surgery approach challenging.

Quasi-static and dynamic mechanical characterization of clay and ballistic soap

Ballistic gelatin, soap, and clay are three human simulated target materials commonly used in the field of wound ballistics research. Currently, there are more studies on ballistic gelatin’s mechanical properties, but rarely on clay and soap. In this paper, the mechanical properties of clay and soap materials were tested by using universal material testing machine and Hopkinson bar, respectively, and their stress-strain curves were obtained under different temperatures (4°C, 15°C, and 25°C) from quasi-static to dynamic loading. The test results showed that the clay material was sensitive to temperature and strain rate in quasi-static conditions, its stress-strain curves showed nonlinear strengthening characteristics, and the stress always increased without strength decrease during the loading process; the dynamic compression mechanical properties of clay were significantly higher than the quasi-static mechanical properties, showing obvious strain rate strengthening effect. In quasi-static compression experiments, the stress-strain curves of soap material showed bilinear elastic-plastic material characteristics; when the strain was less than 0.1, it was insensitive to temperature and strain rate, and only when the strain was more significant than 0.1 did it show a certain temperature and strain rate correlation. The dynamic compressive mechanical properties of soap are significantly higher than the quasi-static mechanical properties, showing a significant strain-rate strengthening effect. The stress of soap at the same strain rate is slightly less than that of clay. These results not only help provide more accurate material parameters for relevant numerical calculations but also help to provide references for the development of new bionic materials.

Early Clinician Exposure to the Physiologic Damage of Firearms: A Feasibility Study

Introduction:In comparison to many nations in the developed world, the United States has more cases of civilian ballistic injuries. Both low and high velocity firearm injuries are frequently encountered in American urban trauma centers, and physicians become familiar with these traumatic injury patterns. Physicians from other nations may rarely encounter such injuries. With an increase in international conflict, there is an increased need for clinicians to participate in international medical aid which may include patients with ballistic injuries. Clinicians with limited familiarity of such injuries may result in under-triage and delayed recognition of injury severity, resulting in increased morbidity and mortality of patients. This study aims to show that a course on ballistic injuries will improve clinician recognition of injury patterns and comfort levels managing these patients.Method:Clinicians participated in a course which was designed to introduce ballistic injury patterns. The course was reviewed and supported by emergency medicine physicians who work in a large level I trauma center in the Southeastern United States and serve in clinical roles with EMS and community law enforcement. Course content included demonstrations of firearm injuries by discharging weapons into gels and models designed to replicate human body tissue. Participants were surveyed prior to and after completing the course regarding their comfort with firearms and firearm related injuries.Results:Participants reported increased comfort level with the management of ballistic injuries. The course requires a full day of expert physician time, approximately US$600 in supplies if performing live demonstrations, and the cost of designated space for safe firearm discharge and use.Conclusion:This course or a similar course with pre-fired demonstration rounds proved to be feasible and beneficial for those who will likely encounter firearm injuries in their clinical environment. There are both quantifiable and perceived benefits for physicians.

Kiwi Ingenuity – How New Zealand Healthcare Adapted for the Whakaari/White Island Disaster

Introduction:New Zealand is widely known across the globe as an adventure tourism destination. On December 9, 2019, the natural wonders of the country became a major disaster that impacted the lives of many and stretched the resources of the New Zealand healthcare system.Whakaari/White Island is an uninhabited, privately owned island 50 km off the North Island of New Zealand. It contains two strato-volcanoes, which were and remain a popular tourist destination. While an international tourist group were enjoying their guided tour of the crater, one of the volcanoes erupted, sending superheated debris and gas into the air. Of the 47 individuals on the island at the time, 39 were rescued. Overall, 25 people survived. The mortality of this event was significantly lower than historic volcanic eruptions involving ballistic and pyroclastic injuries. We are fortunate to present information specifically on the chemical and physiological changes noted from exposure to volcanic ash.Located in New Zealand’s largest city is Middlemore Hospital, home of the National Burns Center. This center is supported by three regional burn centers throughout the country. Prior to Whakaari, mass-casualty plans were in place, however, system-wide adaptations were required on many levels to ensure delivery of healthcare. This included changes in pre-hospital triage, support for regional burns centers and repatriation to home countries.This poster presentation takes you on the journey of adaptation experienced within the National Burns Service, focusing on operating theater, intensive care and acute burns management.Method:Case StudyResults:.Conclusion:.

Mechanism matters: A 10-year experience of ballistic injuries of the upper extremity

IntroductionUpper Extremity gunshot wounds represent a significant strain on community and hospital resources, and reports of their epidemiology are varied. We hypothesized that demographic and socioeconomic variables would be associated with variable injury patterns and management, and that two distinct populations would be affected by upper extremity ballistic injury based on violent versus accidental, self-inflicted mechanism. Materials & methodsRetrospective review of all adult patients sustaining ballistic injury to the upper extremity at a single urban Level I trauma center over 10 years (n = 797). Demographic, injury pattern, treatment, and outcomes data were collected. Comparisons between groups were conducted with unpaired t-tests and chi-square testing where appropriate. ResultsMost patients were male (89.1%) and mean age was 30.1 years (18-83). Violence accounted for 89.1% of injuries. Black individuals were disproportionately affected at 87% of patients. Shoulder injuries were most common (34%), and wrist least common (7%). Demographics and injury pattern varied significantly between patients sustaining violent injury and those with self-inflicted mechanisms. Patients sustaining violent injury were most often young, Black men more likely to be injured proximally, whereas patients with self-inflicted injuries were more likely to be older, Caucasian men with more comorbidities injured distally. Cumulatively, 35.3% of patients required operative intervention. Distal injuries were more likely operative. The most commonly injured structure across all levels was bone (53%), and 54.3% of fractures required operation. Median follow-up was 24.5 months. Complication rate was 13.6%. ConclusionsGunshot wounds of the upper extremity create complex patterns of injury which vary based on level of injury and mechanism. Violent and self-inflicted injuries occur in dissimilar populations and result in distinctive injury patterns.