Pathology
- Kinetic energy rises with the square of velocity
- Low velocity handgun projectiles cause a narrow permanent cavity
- High velocity rifle projectiles create a large temporary cavity that destroys tissue well beyond the track
- Yaw and fragmentation increase tissue damage
- Tissue damage depends on energy transferred, not projectile speed alone
- Clothing and debris are carried into the wound
- Shotgun wounds at close range behave like high energy injuries
Classification
| Blast type | Mechanism | Injuries |
|---|---|---|
| Primary | Overpressure wave | Tympanic membrane, lung and bowel injury |
| Secondary | Fragments and debris | Penetrating wounds and contamination |
| Tertiary | Body thrown or crushed | Fractures and traumatic amputation |
| Quaternary | Heat, smoke and toxins | Burns and inhalation injury |
Management
- ATLS approach with damage control resuscitation
- Check pulses, compartments and nerves
- Low velocity wounds, local wound care and treat the fracture by its own pattern
- High velocity and blast wounds, manage as Gustilo III with staged radical debridement
- Delayed wound closure and tetanus cover
- Remove intra-articular projectiles to prevent lead synovitis and toxicity
- Document wounds for forensic purposes
- Tetanus prophylaxis and early broad spectrum antibiotics
- Fasciotomy for compartment syndrome
- Remove only accessible fragments, especially from joints
- Lead toxicity can follow retained fragments in joints
- Consider forensic requirements when handling projectiles
Related Pages
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.