Determining the wounding effects of ballistic projectiles to inform future injury models: a systematic review
- 18 June 2013
- journal article
- research article
- Published by BMJ in Journal of the Royal Army Medical Corps
- Vol. 160 (4), 273-278
- https://doi.org/10.1136/jramc-2013-000099
Abstract
Introduction Penetrating wounds from explosively propelled fragments and bullets are the most common causes of combat injury experienced by UK service personnel on current operations. There is a requirement for injury models capable of simulating such a threat in order to optimise body armour design. Method A systematic review of the open literature was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. Original papers describing the injurious effects of projectiles on skin, bone, muscle, large vessels and nerves were identified. Results Projectiles injure these tissues by producing a permanent wound tract (PWT), comprised of a central permanent wound cavity, in conjunction with a zone of irreversible macroscopic tissue damage laterally. The primary mechanism of injury was the crushing and cutting effect of the presented surface of the projectile, with an additional smaller component due to macroscopic damage produced by the radial tissue displacement from the temporary tissue cavity (TTC). No conclusive evidence could be found for permanent pathological effects produced by the pressure wave or that any microscopic tissue changes due to the TTC (in the absence of visible macroscopic damage) led to permanent injury. Discussion Injury models should use the PWT to delineate the area of damage to tissues from penetrating ballistic projectiles. The PWT, or its individual components, will require quantification in terms of the amount of damage produced by different projectiles penetrating these tissues. There is a lack of information qualifying the injurious effect of the temporary cavity, particularly in relation to that caused by explosive fragments, and future models should introduce modularity to potentially enable incorporation of these mechanisms at a later date were they found to be significant.Keywords
This publication has 36 references indexed in Scilit:
- Developmental framework to validate future designs of ballistic neck protectionBritish Journal of Oral and Maxillofacial Surgery, 2013
- Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA StatementJournal of Clinical Epidemiology, 2009
- Gunshot Wound ReviewAnnals of Emergency Medicine, 1996
- Gunshot wounds: 1. Bullets, ballistics, and mechanisms of injury.American Journal of Roentgenology, 1990
- Interaction of penetrating missiles with tissues: Some common misapprehensions and implications for wound managementBritish Journal of Surgery, 1990
- Pressure Waves Caused by High-Energy Missiles Impair Respiration of Cultured Dorsal Root Ganglion CellsThe Journal of Trauma and Acute Care Surgery, 1990
- Pressure Wave Injuries to the Nervous System Caused by High-energy Missile Extremity Impact: Part I. Local and Distant Effects on the Peripheral Nervous System—A Light and Electron Microscopic Study on PigsThe Journal of Trauma and Acute Care Surgery, 1990
- Wounding Effects of Small Fragments of Different Shapes at Different Velocities on Soft Tissues of DogsThe Journal of Trauma and Acute Care Surgery, 1988
- Early Pathomorphologic Characteristics of the Wound Track Caused by FragmentsThe Journal of Trauma and Acute Care Surgery, 1988
- The Wound Profile: Illustration of the Missile-tissue InteractionThe Journal of Trauma and Acute Care Surgery, 1988