A civilian perspective on ballistic trauma and gunshot injuries

Abstract

Background: Gun violence is on the rise in some European countries, however most of the literature on gunshot injuries pertains to military weaponry and is difficult to apply to civilians, due to dissimilarities in wound contamination and wounding potential of firearms and ammunition. Gunshot injuries in civilians have more focal injury patterns and should be considered distinct entities.

Methods: A search of the National Library of Medicine and the National Institutes of Health MEDLINE database was performed using PubMed.

Results: Craniocerebral gunshot injuries are often lethal, especially after suicide attempts. The treatment of non space consuming haematomas and the indications for invasive pressure measurement are controversial. Civilian gunshot injuries to the torso mostly intend to kill; however for those patients who do not die at the scene and are hemodynamically stable, insertion of a chest tube is usually the only required procedure for the majority of penetrating chest injuries. In penetrating abdominal injuries there is a trend towards non-operative care, provided that the patient is hemodynamically stable. Spinal gunshots can also often be treated without operation. Gunshot injuries of the extremities are rarely life-threatening but can be associated with severe morbidity.With the exception of craniocerebral, bowel, articular, or severe soft tissue injury, the use of antibiotics is controversial and may depend on the surgeon's preference.

Conclusion: The treatment strategy for patients with gunshot injuries to the torso mostly depends on the hemodynamic status of the patient. Whereas hemodynamically unstable patients require immediate operative measures like thoracotomy or laparotomy, hemodynamically stable patients might be treated with minor surgical procedures (e.g. chest tube) or even conservatively.

Figure 1

The mechanism of cavitation can cause tissue destruction along the bullet diameter.

Figure 2

CT-scan of a lethal gunshot injury of the brain with massive swelling and increased pressure despite of craniotomie. The patient died despite of immediate craniotomie.

Figure 3

Bilateral chest tubes have been inserted after gunshot injury. The bilateral haematopneumothrax have been drained sufficient.

Figure 4

CT-scan: Spinal gunshot with destruction of the spinal cord. These injury caused a complete paraplegia and an unstable fracture of the vertebra.