Ballistic trauma caused by military rifles: experimental study based on synthetic skull proxies

Rifles are often involved in violent deaths such as homicide and suicide. Consequently, expert knowledge and experimental forensic investigations are important to clarify the nature of ballistic trauma when applied to the human head and neurocranium. This study investigated differences in entrance wound morphology with Synbone® spheres which are described as being comparable to human flat bones. A series of ballistic experiments were conducted using two different rifle calibers (5.56 × 45 mm and 7.62 × 39 mm Full Metal Jacket (FMJ)). Synbone® spheres were used for close-range 0.3 m simulated executions as well as at 25 m and 35 m to simulate urban and military engagements. Results were compared with previously published experimental studies using similar military ammunition. In our study, entry wound morphology closely resembles real forensic cases compared to exit wound and overall shape morphology independently of the distance and the caliber. Circumferential delamination was clearly visible with full metal jacket (FMJ) rounds, yielding similar damage pattern morphology to the human crania. This study documented the presence of hydraulic burst or shock in all ten rounds from all three distances. Krönlein shots were also observed in some cases. Synbone® spheres constitute an acceptable synthetic surrogate for ballistic experiments. The present study offers new initial data on the behavior of Synbone® proxies in ballistic testing of military ammunitions; FMJ gunshot injuries to the human head, for distances that have not previously been published, suggesting that efficient tests can take place under these conditions. Further research on experimental ballistics with a larger number of controlled factors and multiple repetitions is recommended to verify the results of this pilot study before applied in forensic simulations.

Intraocular Foreign Bodies: Clinical Characteristics and Factors Affecting Visual Outcome

Objective. To investigate the clinical characteristics and factors affecting visual outcome in patients with intraocular foreign bodies (IOFBs) and determine the risk factors for the development of endophthalmitis. Study Design. A retrospective case-series study design was adopted. Subjects. In total, 242 patients (242 eyes) who were hospitalized and underwent surgical treatment for IOFB at the Second Hospital of Hebei Medical University between January 1, 2008, and December 31, 2019, were included. Methods. The demographic data, cause of injury, characteristics of IOFBs, postinjury ocular manifestations, and surgical details of the subjects were collected, and the factors affecting visual outcome and endophthalmitis development were analyzed. Results. The most common cause of IOFBs was the propulsion of foreign bodies into the eye due to hammering (149 cases, 61.57%), followed by foreign body penetration (57 cases, 23.55%). Most of the subjects were young adult men who sustained injuries in the work environment. Poorer visual outcomes were found in subjects with initial presenting symptoms visual acuity (PVA) < 0.1, largest IOFB diameter ≥ 3 mm, IOFBs located in the posterior segment, wound length > 5 mm, entrance wound length larger than the largest IOFB diameter, concomitant retinal detachment, concomitant vitreous hemorrhage, concomitant endophthalmitis, and concomitant proliferative vitreoretinopathy (PVR). Factors related to the development of endophthalmitis included lens capsule rupture, time of stage 1 repair surgery ≥ 24 h after trauma, removal of IOFBs ≥ 24 h after trauma, and nonadministration of intravitreal antibiotic injection. Conclusion. Among patients with IOFBs, initial PVA < 0.1, entrance wound length larger than the largest IOFB diameter, concomitant endophthalmitis, and concomitant PVR were risk factors for poor visual outcomes. Lens capsule rupture was a risk factor for endophthalmitis development, and the administration of intravitreal antibiotic injection was a protective factor against endophthalmitis development.

PSIII-4 Determining the Efficacy and Safety of Differing Caliber/Ammunition Combinations for the Humane Euthanization and Subsequent Mass Depopulation of Market Weight Pigs

The objective of this proof of concept exercise was to validate a field applicable methodology designed to objectively assess the multiple caliber/ammunition combinations available for the safe and humane euthanization of market weight pigs during mass depopulation events. Heads of an equal number of barrows and gilts (n = 64) were randomly assigned to one of four caliber/ammunition combinations consisting of the .22 LR, .22 Mag, 0.38 Special, and 9mm. Fully jacketed (FMJ) ammunition was discharged from each of four unique firearms while ensuring that the distance from the muzzle to the forehead was consistent. The MIXED procedure of SAS was used to test the fixed effects of sex and caliber. No differences in skull thickness existed between sex (P = 0.32) or caliber/ammunition combination (P = 0.34). There was no difference in entrance wound diameter between the .38 Special and the 9mm (P = 0.15) yet the entrance wound diameter of the .38 Special and 9mm was larger than both the .22 LR and .22 Mag, respectfully (P &lt; 0.0001). The 9mm bullets traveled further into the ballistic gel (P &lt; 0.0001) and the furthest total distance (P &lt; 0.0001). Bullets from the .38 Special traveled further into the ballistic gel and a further total distance than both the .22 LR and .22 Mag (P &lt; 0.0001). There was no difference in the measurable trauma area of the brain for the 9mm bullets compared to .38 Special bullets (P = 0.83). The measurable trauma area of the brain was greater for the 9mm and .38 Special bullets when compared to both the .22 LR and .22 Mag (P &lt; 0.0001). In conclusion, the efficacy and safety of the multiple caliber/ammunition combinations available for use in the euthanization of market weight pigs can be objectively quantified, replicated, and reported.

Pattern of Abdominal Stab Injury in a Tertiary Hospital in Nigeria

Background: Abdominal stab injury is a type of penetrating abdominal injury. The management may be operative or non-operative. Objectives: To determine the pattern, treatment options and outcome in abdominal stab injuries. Methods: This was a retrospective study carried out over 4 years between January 2014 and December 2017, at the University of Benin Teaching Hospital, Benin City, Nigeria. Patients aged 18 years and above formed the study population. The case files of the patients were retrieved from the medical record. The information obtained included age, gender, injury to arrival time (IAT), type of weapon, the abdominal injury sustained, clinical symptoms and signs, surgical intervention time (SIT), type of surgery carried out, operative findings and complications. Results: Overall, there were 34 patients made up of 30 (88.2%) males and 4 (11.8%) females with a male to female ratio of 7.5:1. The mean age of the patients was 30±8.9 years with the age range of 17-50 years. The mean injury to arrival time (IAT) was 2.0±1.6 hours; surgery intervention time (SIT) was 5.9±5.6 hours. Twenty (58.8%) patients had laparotomy while 14 (41.2%) were successfully managed non-operatively. Post-operative complications included surgical site infection (SSI), entrance wound infection, intra-peritoneal abscess and intestinal obstruction. There was no mortality. Conclusion: Abdominal stab injury was predominant among males and can be managed by the operative method or non-operative method in the absence of significant visceral injury. Selective non-operative management was effective in avoiding unnecessary laparotomy in more than one-third of the cases.

Transfixing abdominal gunshot wound without intra-abdominal lesions: A case report

Background Abdominal gunshot trauma is considered the third leading cause of death in the USA and is responsible for more than 90% of deaths among young people aged 15 to 24. It leads to multi-systemic organ damage, shock, and infection. Case presentation A 20-year-old male alcohol and tobacco user with no relevant health history was admitted at Hôpital de l’Université d’Etat d’Haïti, in the emergency Surgery Department for an abdominal bullet wound. The initial clinical examination was unremarkable except for the presence of hemorrhagic lesions. A few hours later, the patient became diaphoretic, complained of abdominal pain. In view of his rapidly developing condition, he was prepared for the operating room. An exploratory laparotomy was performed, in which 100 cc of blood was found effusing into the abdominal cavity, without any intraperitoneal visceral damage. Systematic exploration showed retroperitoneal hematomas in zone II, where a wound in the psoas muscle was found on the posterior left, in the path of the exit wound of the projectile. Bone splinters were also present on the right in the path of the entrance wound, indicating a fracture of the iliac bone.Conclusion This case reminds us about the uncertain trajectory of projectiles in abdominal gunshot wounds and the possible lesions to which one is exposed, and that despite the apparent hemodynamic stability exploratory laparotomy still has its place where medical imaging technology is not available.

Investigating antemortem, perimortem and postmortem injuries: forensic implication

Context:Skeletal injuries discovered from human remains are classified into antemortem,perimortem and postmortem. Studies that documents injuries of various skeletal elementsis of vital importance to forensic anthropologist. Aim: This study investigated antemortem,perimortem, postmortem and other injuries caused by various instruments among skeletal elements. Methodology: A total of 200 bones of unknown age and gender were studied.Injuries were interpreted based on basic features specific to them and each was described andphotographed. Chisquare test was used to show association between skeletal elements andtime of injuries. Statistical evaluation was done using SPSS 20 Software Version. Significance was accepted at p<0.05. Result: The bones from this study showed 17.50% antemortem, 24%perimortemand 57% postmortem. Findings showed that 49.50% of the bones had blunt forceinjury, 30.50% had sharp force while 20.00% had ballistic injuries. Basic features of antemorteminjuries were smooth and round fractured edges within bones. Sharp, smooth fractured edgeswere observed among perimortem bones in contrast to irregular, blunt fractured edges anduneven discoloration in postmortem bones .Straight line incisions were seen in bones withsharp force injuries,presence of an entrance wound in ballistic injuries while an impact area wasdiscovered in most bones with blunt force injury.Findings showed that there exist a significantassociation between ante, peri and postmortem injuries in the ulnar,radius and femur bones(X2=25.32;13.35;10.11. p=0.000;0.001,0.006) Conclusion: Bones from this study showed morepost mortem blunt force injury. Bangladesh Journal of Medical Science Vol.20(1) 2021 p.50-57

A RARE FOREIGN BODY IN THE CHEST UNDER COVID-19 EPIDEMIC CONDITIONS

One of the negative factors of civilization around the world is the significant growth of injury rate. The manifestations of the latter include suicidal acts that occur in the process of social and individual life. Sometimes people commit suicide because of having incurable diseases. Alcohol addiction contributes to suicide risk. To share with the general medical community the rare case of suicidal trauma which seemed fatal but resolved favorably, though it was not immediately verified. Only after performing a radiological examination in two projections, the subject of suicidal action was detected. We observed a case of a suicide victim: a 55-year-old patient who, being impaired by alcohol, decided to commit suicide after learning about COVID-19 mortality. One hour later he was admitted to the emergency department. After stabbing himself with a kitchen knife, a 55-year-old patient called an ambulance and was delivered in satisfactory condition to the emergency surgical department 1 hour after the injury. There were no signs of bleeding or its consequences or manifestations of vena cava compression. Hemodynamics was stable; there were no external respiration disorders. Clinical blood test was within normal range. Revision of the wound in the lower neck was performed. At a depth of 2.5 cm, something perceived as a sternal notch was located manually, which later turned out to be a foreign body. Due to the location of the injury, it was decided to hospitalize the injured patient for observation. Plain and lateral radiography was performed. Longitudinal sternotomy was chosen for access. Under the entrance wound in the neck, in the lateral mediastinum above the root of the lung, a knife was found above the diaphragm penetrating the parenchyma of the lower lobe. After removing the knife, the lung wound was sutured. The postoperative period ended successfully. Before surgery, an imaging study with at least two different views is mandatory for all chest wounds. If possible, thoracotomy should be scheduled for the daytime.

Non-powder Lateral Penetrating Craniocerebral Gunshot Wound in a 10-Year-Old Girl: A Case Report

Background: Non-powder lateral penetrating craniocerebral gunshot wounds (PCGW) is one of the lethal types of penetrating head injury. The mortality rate is higher in adults than in pediatric populations and influence by the clinical and radiologic findings as the important predictors for prognostication in patients with PGCW. Case Presentation: A 10-year-old girl presented with a gunshot wound to the head 1 day prior. She was accidentally shot by her brother with an air gun from approximately 2 feet from the gun barrel. She develops a loss of consciousness for 30 minutes and weakness over the left arm. In physical examination, the patient Glasgow Coma Scale (GCS) was E3 V5 M6, weakness on the left arm, and an entrance wound over the right temple without an exit wound. The skull X-ray show the pellet fragment and the computed tomography (CT) scan show the bullet track starting from the right frontotemporal towards the left parietooccipital region, damaging both hemispheres with associated intraventricular hemorrhage (IVH). She undergoes a craniotomy procedure to remove the bullet fragment, debridement of the necrotic tissue, and evacuating the blood clot the formed over the bullet track. The patient discharge after postoperative day 7 with good recovery of neurological function and good GCS and Glasgow Outcome Scale (GOS) score. After 6 months follow-up, neither a new deficit nor other signs and symptoms were developed.Conclusions: Non-powder PCGW can cause significant damage to the intracranial compartment, despite its low velocity. The mortality rate in pediatrics is lower than in adults population. The management mandated an urgent surgical procedure to remove any blood clot and debridement of any foreign bodies encountered. Such complications in short- or long term can be developed in any patients and should be treated expectantly.