Crossbow Injuries Research Articles

Penetrating Crossbow Injury to the Head: A Case of Suicide.

Penetrating Crossbow Injury to the Head: A Case of Suicide.

Crossbow Injuries: Predictors of Mortality.

Crossbow injuries are rare but carry significant morbidity and mortality, and there is limited evidence in the medical literature to guide care. This paper reviews the case reports and case series of crossbow injuries and looks for trends regarding morbidity and mortality based on the type of arrow, anatomic location of injury, and intent of injury. Multiple databases were searched for cases of crossbow injuries and data were abstracted into a spreadsheet. Statistics were done in SPSS. 358 manuscripts were returned in the search. After deduplication and removal of nonclinical articles, 101 manuscripts remained. Seventy-one articles describing 90 incidents met the inclusion criteria. The mean age was 36.5 years. There were 10 female and 79 male victims. Fatality was 36% for injuries by field tip arrows and 71% for broadhead arrows, p = .024. Assaults were fatal in 84% of cases, suicides in 29%, and accidental injuries in 17%, p < .001. Mortality was similar for wounds to the head and neck (41%), chest (42%), abdomen (33%), extremities (50%), and multiple regions, p = .618. Crossbows are potentially lethal weapons sold with fewer restrictions than firearms. Injuries caused by broadhead arrows are more likely to be fatal than injuries from field tip arrows. The anatomic location of injury does not correlate with fatality. More than half of crossbow injuries are due to attempted suicide, with a high case-fatality rate.

Managing penetrating renal trauma: experience from two major trauma centres in the UK.

To present our series of patients with penetrating renal trauma treated at two urban major trauma centres and to discuss the contemporary management of such injuries. We reviewed prospective urological trauma databases for all patients presenting with penetrating renal trauma between January 2005 and October 2016. Patient demographics, clinical characteristics, imaging, management and follow-up data were analysed. Over the 11-year period, 63 patients presented with penetrating renal injuries. The vast majority of patients were male (n = 61; 96.8%), with a mean (range) age of 27.4 (14-71) years. Injuries were equally common on either side (31 left, 32 right). The most common mechanism of injury was stabbing (n = 55; 87.3%), followed by gunshot (n = 7; 11.1%) and crossbow injuries (n = 1; 1.6%). All patients underwent contrast-enhanced computed tomography. Using the American Association for the Surgery of Trauma renal injury grading system, 11 (17.5%) had grade II, 26 (41.3%) had grade III and 26 (41.3%) had grade IV injury. The most common associated injuries were thoracic (n = 23; 36.5%), liver (n = 11; 17.5%), splenic (n = 10; 15.9%), gastrointestinal tract (n = 8; 12.7%) and musculoskeletal (n = 6; 9.5%). At presentation, 16 patients (25.4%) were haemodynamically unstable. The majority of patients did not require blood transfusion (n = 56; 88.9%), while transfusion of >5 units was rare (n = 4; 6.3%). Fifty-two patients (82.5%) were managed by observation alone, while 10 (15.9%) underwent emergency angiography and embolization. Patients with grade IV injury were more likely to require embolization than those with grade III injury; however, the difference was not significant (26.9% vs 15.4%; P = 0.29). One patient (1.6%) underwent retroperitoneal exploration of their renal injury and was managed conservatively. Eight patients underwent laparotomy for other visceral injuries while their renal injury was managed conservatively. Renal artery pseudoaneurysm developed in five patients (7.9%) and one patient (1.6%) developed renal arteriovenous malformation. No patients underwent nephrectomy and no mortality was reported. The vast majority of patients with penetrating renal injuries can be safely managed non-operatively in this setting. Selective renal artery embolization is an effective option for patients in an unstable condition, with excellent outcomes. Associated thoracic or visceral injuries requiring operative management are common in penetrating renal trauma, while urologists should limit or have a high threshold for surgical intervention.

Endoscopic repair technique for traumatic penetrating injuries of the clivus

Unlike basilar skull fractures, penetrating traumatic injuries to the clivus are uncommon. We present two novel and interesting cases of traumatic crossbow arrow injury and penetrating screwdriver injury to the clivus. A review of the literature describing methods to repair these injuries was performed. A careful, systematic approach is required when working up and treating these injuries, as airway preservation is critical. An adaptation to the previously described “gasket-seal” method for skull base repair was utilized to repair the traumatic cerebrospinal fluid (CSF) fistulas. This repair technique is unique in that it is tailored to a much smaller defect than typical post-surgical defects. Two patients are presented, one with a post-traumatic CSF fistula after penetrating crossbow injury to the clivus and one with a penetrating screwdriver injury to the clivus. The patients were treated successfully with transnasal endoscopic repair with fascia lata graft and a nasoseptal flap, a novel adaptation to the previously described “gasket-seal” technique of skull base repair.

A Rare, Combined Cardiac and Hepatic Crossbow Injury

A 32-year-old man presented to our hospital after a failed suicide attempt using a crossbow. The patient had shot himself in close range with a double-barreled crossbow, simultaneously two arrows, in the chest. In spite of his life-threatening injuries, the man survived. The lodged arrows helped to avoid tremendous loss of blood. After his arrival in the hospital, the surgical removal of the arrows proceeded under direct visualization with corresponding sutures on the heart and liver. The patient's postoperative course was uneventful.

Retained Crossbow Bolt after Penetrating Facial Trauma

Objective: 1) Describe a challenging case of removal of a retained crossbow bolt from the maxillofacial region. 2) Review the surgical management techniques. 3) Review of the literature on crossbow injuries to the head and neck. Method: Case report is of a unique mechanism of penetrating maxillofacial trauma with retained foreign body threatening airway and neurovascular injury. Pertinent literature is reviewed. Results: A 31-year-old man presented after being shot twice in the head with crossbow bolts. He was stable on clinical evaluation, and CT revealed an 8.5-cm retained crossbow bolt extending from the right infratemporal fossa through the pterygopalatine fossa, traversing the nasopharynx with the tip just medial to the left mandibular ramus. There was no apparent vascular injury on CT angiogram. After awake tracheostomy for airway control, the bolt was removed by mandibular swing approach combined with nasal endoscopic assistance. Postoperative course was uneventful and follow-up showed excellent wound healing without complications. Conclusion: Otolaryngologists often encounter penetrating injuries and retained foreign bodies to the maxillofacial region. The unique shape of a crossbow bolt, along with threat of airway and neurovascular injury, created a management challenge. Herein we discuss various surgical approaches and review the literature on crossbow injuries to the head and neck.

Fatal Suicidal Crossbow Injury—The Ability to Act

We report a case of a 58-year-old man who committed suicide using a modern crossbow. The victim shot himself in the chest with a conical field-tip arrow from close proximity. We first presumed that this was a case of homicide committed with a firearm. We were, however, subsequently proved wrong. The reasons for the primary statement were as follows: the external morphology of the entrance wound being typical of a firearm discharged from long distance; the perforation found on the victim's clothing; the absence of the firearm at the place of death; the absence of the arrow in the wound. All of these reasons forced us initially to conclude that the case was one of homicide. In the reported case, the man, after having been shot with an arrow, was further able to act, even though the abdominal aorta and liver were seriously injured. While the arrow was in the wound, the injuries may not have led to massive bleeding because of incomplete tamponade of the defects by the arrow shaft. Pulling the arrow out of the victim's wound track initiated massive bleeding. Despite all these injuries, the man was capable of pulling the bow string again and reloading the crossbow with the arrow used in the first attempt. This case demonstrates that forensic investigations into crossbow injuries can be very difficult, especially when the bolt has been removed from the body.

Crossbow injury in a developed country

Crossbow injuries are not common in developed countries such as Australia and New Zealand. Despite this, there have been a number of crossbow injuries in New Zealand mainly related to hunting exercises. When such incidents occur, it is important for the surgeons involved in the emergency care of the patient to have some background in the management of these injuries. A 24-year-oldmanpresented to the emergency department (ED) with a crossbow bolt penetrating his left supraclavicular fossa. A broad head arrow was accidentally fired with a high powered crossbow during a hunting exercise and travelled approximately 30 m before striking the jaw (resulting in a superficial laceration) and the left supraclavicular fossa (Fig. 1a). Theaccident occurred in a rugged terrain resulting in 4-h delay in transfer to ED. Vital signs on arrival were: pulse 88 beats/min, systolic blood pressure 140mmHg (after 1 l of normal saline), oxygen saturation 100% (trauma mask) and respiratory rate 32 breaths/min. Chest X-ray (CXR) showeda left haemothoraxwith the arrow traversing through the left supraclavicular fossa into the thoracic cavity (Fig. 1b). Insertionofan intercostal chestdrain immediatelydrained600 mlof bloodwith resolution of the haemothorax on repeat CXR. Therewas minimal chest drain output with no air leak and the patient remained haemodynamically stable. He was then transferred for a computerised tomography (CT) scan. The shaft of the bolt had to be carefully shortened in order for the patient to fit into the scanner. The CT scan (Fig. 2) showed that the bolt lodged posterior to the left carotid sheath, trackingmedially across the left first intercostal space, directing downwards and posterior across the vertebral processes with its tip at the right erector spinae muscle. There was no obvious vital vascular injury or residual pneumothorax. In the operating theatre, an incision was made in the back where the tip of the bolt was expected to be located based on the CT scan and approximation by gentle manipulation of the bolt (Fig. 3). After the identification of the tip, the bolt was carefully advanced forward

Orbital crossbow injury

Orbital crossbow injury

Crossbow injuries: A case report

Despite the increasing popularity of crossbows in recreational hunting, injuries and deaths from crossbows are still relatively rare. In suicides, the body areas favoured are similar to those of gun users, namely the thorax and head. These deaths almost always occur in males. The case presented is that of a 49 year old male with a history of mental illness and suicidal attempts, who committed suicide with a crossbow. The weapon was discharged into the left thorax. Examination of crossbow injuries can be difficult due to their similarities with other incised wound patterns. As many victims may survive for some time after injury, removal of the bolt is possible. As well, removal of the bolt followed by advanced decomposition may alter the wound patterns. Careful examination of clothing, as well as entry wound reconstruction may give an indication to the weaponry used. Radiology is useful for detecting debris along the wound path, as well as position of the bolt when it is in situ. Finally, when dealing with cases of crossbow head injuries, consideration of both blood loss as well as diffuse axonal damage is important, both in non-fatal and fatal cases.

A Medieval Murder

On rare occasion, the body or skeleton of a murder victim may be discovered hundreds of years, or even millennia, after the crime. The murder of the 5000-year-old Stone Age man, found frozen in the ice of the Italian Alps, being the most recent example. In most of these cases too much time has passed to allow the application of modern forensic technology. We describe here a homicide that occurred between 1310 and 1390. The victim died of a crossbow injury, with a bolt passing between the 2nd and 3rd vertebrae, completely transecting the brainstem. The crossbow was, for more than 2 and one half centuries (1200-1460), the weapon of choice in European armies, and its use would not have been unusual. The choice of weapon, and other features of the crime, makes it possible to arrive at some reasonable conclusions about the circumstances of the death.

Survived Crossbow Injuries

The Hamburg University Institute of Legal Medicine presents 2 cases of injuries of crossbow arrows where the patients survived. Crossbows are used nowadays as sports and hunting weapons. They are freely obtainable, and since people without practice can shoot them, there are constant injuries and fatal cases. Crossbow arrows have a high penetration force and can even pierce bone. Depending on the tip of the arrow used, they bore or cut through tissue, here damage to the tissue being restricted to the direct surroundings. Due to the elasticity of the tissue, the arrow shaft in the wound track may have the effect of an incomplete tamponade so that major hemorrhaging is prevented. In this condition, the injured person may be conscious and capacitated. From the medical viewpoint, crossbow arrows should therefore be invariably left in the wound, secured against displacement during transport, and only removed in the hospital.

Fatal and non-fatal injuries caused by crossbows

Today in modern times, traumatic injuries caused by crossbows are a rarity. The largest collection of cases so far is presented in this study, consisting of four fatalities (two homicides and two suicides) and two non-fatal injuries (grievous bodily harm and an accident). All the victims were male having an age between 31 and 54. The weapons, which were used, were mainly high-performance precision crossbows with telescopic sights and hunting bolts. The parts of the body involved were the facial/head area in three of the cases and the thorax in three of them. There were either deep or total penetration injuries to the cranium and thorax with the bolt remaining in the wound in four out of six cases. The persons with non-fatal crossbow injuries exhibited comparatively few symptoms, despite the sometimes extensive involvement of the interior of the cranium (cerebrocranial penetration, in one instance). The two cases of suicide favoured the body areas often found with gun-users. The aetiological classification of crossbow injuries may be difficult after the removal of the bolt. The external morphology is strongly dependent on the type of tip used. Multiple-bladed hunting broadheads produce radiating incised wounds, whereas conical field tips produce circular to slitlike defects. Correspondingly, the external injuries can be reminiscent of the effects of a violent attack by sharp force or of a gunshot wound. The possibility, supported by clinical data, that the victim might have the ability to act or even to survive for a period of time, even with penetration of the brain, should be taken into account when the cause of death is being investigated.

Non-lethal penetrating cardiac injury from a crossbow bolt

Crossbow injuries to the thorax are nowadays uncommon. The type of arrowhead used determines not only the form of entrance wound but often the outcome of these injuries. We report the case of a 38-year-old man who attempted to commit suicide by firing a bolt from a sport crossbow into his heart. Although the bolt penetrated the mediastinum causing a deep intraseptal myocardial lesion and the pre-operative diagnostic procedure delayed the necessary operation, the patient survived.

Non-lethal penetrating cardiac injury from a crossbow bolt

Crossbow injuries to the thorax are nowadays uncommon. The type of arrowhead used determines not only the form of entrance wound but often the outcome of these injuries. We report the case of a 38-year-old man who attempted to commit suicide by firing a bolt from a sport crossbow into his heart. Although the bolt penetrated the mediastinum causing a deep intraseptal myocardial lesion and the pre-operative diagnostic procedure delayed the necessary operation, the patient survived.

Arrow Damage to Textiles—Analysis of Clothing and Bedding in Two Cases of Crossbow Deaths

Two cases of crossbow deaths involving analysis of damage to clothing and bedding are described. The distinctive characteristics of the damage examined in these cases indicate that there is merit in examining damage to clothing as well as wounds to the body in crossbow injuries. Clothing damage analysis may be especially useful if the body is badly decomposed or never recovered. Furthermore, damage to textiles may reflect a clearer geometry of the weapon than that of the associated wounding.

Transoral Crossbow Injury to the Cervical Spine: An Unusual Case of Penetrating Cervical Spine Injury

Abstract The complexity of missile injuries to the cervical spine has increased as the technology that causes these injuries has become more sophisticated. Management requires adaptation of conventional neurosurgical approaches to the cervical spine in an effort to limit neurological deficit and establish stability. We report an unusual case of a 19-year-old man who suffered transoral penetration of the cervical spine by an arrow released by a crossbow at close range.

Transoral crossbow injury to the cervical spine

The complexity of missile injuries to the cervical spine has increased as the technology that causes these injuries has become more sophisticated. Management requires adaptation of conventional neurosurgical approaches to the cervical spine in an effort to limit neurological deficit and establish stability. We report an unusual case of a 19-year-old man who suffered transoral penetration of the cervical spine by an arrow released by a crossbow at close range.