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Traumatic injuries from civilian gunshot injuries represent a significant clinical burden to orthopaedic surgeons worldwide. Furthermore, the incidence of such injuries is increasing. Having a sound understanding of the pathophysiology associated with gunshot injuries and the appropriate management algorithm is vital. This chapter aims to review the current evidence regarding the incidence and prevalence of civilian ballistic trauma, the pathophysiological processes associated with these injuries, and the recommended management from emergent care at the time of injury to definitive surgery and rehabilitation. [ABSTRACT FROM AUTHOR]

The insufficient recognition of injuries by the BB-gun (regarded as toys for children) has led to its increasing misuse without permission, which has caused many public safety issues. Aiming to enhance the understanding of the injuries by the BB-gun, the experimental and numerical study of BB-Gun pellet penetrating "cowhide + gelatine" composite target was comprehensively carried out. It was confirmed from the experiment that BB-Gun is capable of inflicting severe or fatal wounds to important organs, and perforating the skin or not could be employed to evaluate the safety of BB-guns. Moreover, three forms of ballistic limit (including: velocity, kinetic energy and specific kinetic energy) of typical BB were calculated and analyzed by reasonably validated numerical simulation method. Additionally, a formulation was acquired by dimensional analysis based on the simulation results and was verified to accurately predict the ballistic limit velocity of BB with different mechanical properties. The method may help to improve the understanding on the minimal velocity needed to perforate skin and may be advised as the determination of the safety of BB-gun. [ABSTRACT FROM AUTHOR]

Synthetic models, also called "surrogates", are commonly used in wound ballistics in order to simulate human tissues. Despite several surrogates are worldwide accepted and used; some of them have not been yet fully validated and their limits for forensic reconstructions have not been deeply investigated yet. In this work we present a homicide/suicide case involving three gunshots to the head with bullets retained in the skull or beneath the scalp. Reconstruction of these cases was performed preparing three individual synthetic head models based on post-mortem computed tomography (PMCT) measurements. Ballistic soap, polyurethane plates and 10% ballistic gelatine at 4°C were used as simulants in individually adapted thickness. Ballistic tests were performed using the questioned firearm and ammunition type. The damages on the synthetic models have been compared to the findings in PMCT and autopsy of the victims. Although the results highlighted general similarities in terms of injury characteristics, some of the experimental shots overpenetrated. Furthermore, the bullets recovered in the synthetic models did not show the same quality of deformations as the questioned bullets. This lack of bullet deformation in the synthetic models might be mainly attributed to the physical difference between real bones and polyurethane surrogate. [ABSTRACT FROM AUTHOR]

Gun violence is a global phenomenon with regional variation in frequency and severity. Handguns are often used in violent deaths such as suicides and homicides. Hence, ballistic trauma is a critical subject of forensic investigations. Trauma patterns are fundamental evidence for the reconstruction of the incident and for the determination of the manner of death. This study investigated the differences in trauma patterns with a series of experiments using six different calibers (.22 LR, .38 Special, .380 ACP, 9×19mm, .40 S&W, and .45 ACP) and four different bullet types. Synbone® spheres (polyurethane bone proxies) were used for close range 30cm simulated executions. The polyurethane spheres constitute an excellent proxy for human crania at the macroscopic level as suggested by other studies. The results showed that the radius of the entrance wound is positively correlated (Pearson's correlation coefficient R=0.846, p<0.05) with the caliber dimension. As muzzle velocity increased, endocranial beveling increased. Bullet weight, conversely, does not seem to have an effect on the size of the endocranial beveling present in Synbone® spheres. The ballistic experiments exhibited similarities in entrance wound morphology; radial and concentric fracture patterns, hydraulic burst effect, circumferential delamination, and endocranial beveling with that of documented forensic cases with corresponding caliber shot. Synbone spheres seem appropriate for ballistic simulations of cranial injuries; yet, more research is needed to verify these observations. [ABSTRACT FROM AUTHOR]

• A mole gun can be diverted from its classic use to become a homemade firearm. • The use of this homemade firearm has caused serious intracorporeal injuries. • The ballistic analysis of homemade firearms is essential for understanding the facts. The body of a man was found in a workshop at the back of his home, a metal pipe embedded in his chest. In the immediate vicinity of the body, among various tools, was a machine containing a holster hit of lead shot evoking a mole-trap-type "taupe gun" (mole gun). The findings at the scene and the presence of a metal tube, sinkers, and a flock in the chest are in favour of the use of a homemade firearm. The autopsy and CT scan revealed atypical ballistic thoracic trauma responsible for a dilaceration of both the heart and thoracic aorta that caused the death. The autopsy also found a contused wound at the back of the skull without intracranial lesion, which may be due to the fall of the victim after the thoracic trauma. There is no other traumatic lesion and in particular no lesion of seizure, constraint, or defense. Toxicological analyses revealed the presence of alcoholic impregnation at the time of death. These findings, confronted with the expertise of a balistician, made it possible to understand how the victim used a mole gun to cause these lesions. A metal tube was used as a cannon to aim more surely at the heart but also as a means of triggering the propulsion mechanism of the trap without having to stretch out the arm. The tube, thinner than the barrel, had disengaged from its tip to be embedded with the lead shot in the chest of the victim. [ABSTRACT FROM AUTHOR]

Introduction: Surgical treatment of high-energy gun-shot wounds (GSWs) to the extremities is challenging. Recent surgical doctrine states that wound tracts from high-energy GSWs should be laid open, however the experience from previous conflicts suggests that some of these injuries can be managed more conservatively. The aim of this study is to firstly characterise the GSW injuries sustained by UK forces, and secondly test the hypothesis that the likely severity of GSWs can be predicted by features of the wound.Methods: The UK Military trauma registry was searched for cases injured by GSW in the five years between 01 January 2009 and 31 December 2013: only UK personnel were included. Clinical notes and radiographs were then reviewed. Features associated with energy transfer in extremity wounds in survivors were further examined with number of wound debridements used as a surrogate marker of wound severity.Results: There were 450 cases who met the inclusion criteria. 96 (21%) were fatally injured, with 354 (79%) surviving their injuries. Casualties in the fatality group had a median New Injury Severity Score (NISS) of 75 (IQR 75-75), while the median NISS of the survivors was 12 (IQR 4-48) with 10 survivors having a NISS of 75. In survivors the limbs were most commonly injured (56%). 'Through and through' wounds, where the bullet passes intact through the body, were strongly associated with less requirement for debridement (p<0.0001). When a bullet fragmented there was a significant association with a requirement for a greater number of wound debridements (p=0.0002), as there was if a bullet fractured a bone (p=0.0006).Conclusions: More complex wounds, as indicated by the requirement for repeated debridements, are associated with injuries where the bullet does not pass straight through the body, or where a bone is fractured. Gunshot wounds should be assessed according to the likely energy transferred, extremity wounds without features of high energy transfer do not require extensive exploration. [ABSTRACT FROM AUTHOR]

Based on its intrinsic mass and velocity, a bullet has an upper limit of wounding potential. Actual wound severity is a function of the bullet construction and trajectory, as well as the properties of the tissues traversed. Interpreting physicians must evaluate the bullet trajectory and describe patterns of injury resulting from the effect of energy transfer from the projectile into living tissue. A basic understanding of firearms, projectiles, and wound ballistics can help the interpreting physicians in conceptualizing these injuries and interpreting these cases. [ABSTRACT FROM AUTHOR]