Ballistic trauma is a type of traumatic injury caused by firearm-related wounds or other projectiles. The damage to tissues depends on the kinetic energy of the projectile, which influences the amount of energy that the object has available to transfer to tissue. Ballistic trauma varies widely based on the bullet, velocity, mass, entry point, trajectory, affected anatomy, and exit point; and can have serious long-term health and economic consequences.
It is in ballistic trauma that perforating trauma is more likely to be found, as opposed to a stabbing or other penetrating injury. Locating and identifying the exit wound is important not only for treatment purposes but also for forensic and crime reconstruction purposes.
Additional injury types include penetrating, the bullet enters the body, but does not exit; re-entry, the bullet enters, exits, then re-enters the body; and graze or tangential, a superficial wound caused by a bullet striking the skin at a shallow angle.
Injuries from ballistic trauma are influenced by many factors to include:
Velocity of the firearm - high-velocity firearms, such as rifles, cause greater and more extensive tissue damage, whereas lower velocity firearms, such as a handgun, cause more localized tissue damage
Projectile characteristics - type, composition, shape, the tendency to explode, deform, or fragment
Density of the affected tissues
Distance of fire
Ballistic trauma involves two primary mechanisms of injury:
Permanent Cavity: This is the direct path taken by the bullet as it crushes and destroys tissue. The extent of this damage depends on the bullet’s type, velocity, and mass, as well as the physical characteristics of the tissues it passes through.
Temporary Cavity: As the bullet travels through the body, it creates a temporary cavity by stretching and shocking the surrounding tissues. This cavity is larger than the bullet itself and can cause significant damage to organs and tissues outside of the bullet’s path.
Common complications following ballistic trauma depend on the location and severity of the injury. Here are some of the most frequent complications:
Infection: Due to the introduction of foreign materials (like bullet fragments or clothing) into the body, infections are a significant risk.
Vascular Injury: Damage to blood vessels can lead to severe bleeding, hematomas, or even loss of limb if not promptly treated.
Nerve Damage: Bullets can sever or damage nerves leading to loss of function or sensation in affected areas.
Fractures: High-velocity bullets can cause complex fractures, which may require extensive surgical intervention.
Compartment Syndrome: Increased pressure within muscle compartments can lead to tissue death and require emergency surgery.
Chronic Pain: Long-term pain, including conditions like hyperalgesia (increased sensitivity to pain), can persist long after the initial injury.
Lead Poisoning: Retained bullet fragments can lead to lead poisoning over time.
Organ Damage: Depending on the trajectory, bullets can cause significant damage to internal organs, leading to long-term complications like bowel obstruction or neurogenic bladder.
