Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Ramat Gan 5262000, Israel.
Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem 9574869, Israel.
Mil Med. 2024 Jan 23;189(1-2):e448-e453. doi: 10.1093/milmed/usad340.
Behind armor blunt trauma (BABT) is a non-penetrating injury caused by energy transfer and rapid deformation of protective body armor. Although modern military body armor is designed to prevent penetrating trunk injuries, high-energy projectiles can produce a significant energy transfer to tissues behind the armor and inflict injuries such as fractures or organ contusions. However, knowledge of BABT is limited to biomechanical and cadaver modeling studies and rare case reports. We report two cases of BABT resulting from close-range fire and discuss the potential implications for triaging patients with BABT in battlefield scenarios. In the first case, a 19-year-old male soldier sustained a single close-range 5.56-mm assault rifle gunshot to his chest body armor. The soldier initially reported mild pain in the parasternal region and assessment revealed a 4 cm × 3 cm skin abrasion. Following emergency department evaluation, the soldier was diagnosed with a non-displaced transverse fracture of the sternal body. In the second case, a 20-year-old male sustained five machine gun bullets (7.62 mm) to his body armor. Computed tomography of the chest revealed pulmonary contusions in the right lower and middle lobes. Both soldiers achieved full recovery and returned to combat duty within several weeks. These cases highlight the potential risks of energy transfer from high-velocity projectiles impacting body armor and the need for frontline providers to be aware of the risk of underlying blunt injuries. Further reporting of clinical cases and modeling studies using high-velocity projectiles could inform recommendations for triaging, evacuating, and assessing individuals with BABT.
背后装甲钝器伤（BABT）是一种由能量传递和防护体装甲快速变形引起的非穿透性损伤。尽管现代军用体装甲旨在防止贯穿躯干的损伤，但高能射弹可向装甲后面的组织产生显著的能量传递，并造成骨折或器官挫伤等损伤。然而，关于 BABT 的知识仅限于生物力学和尸体模型研究以及罕见的病例报告。我们报告了两例由近距离射击引起的 BABT，并讨论了在战场场景中对 BABT 患者进行分诊的潜在影响。在第一个病例中，一名 19 岁的男性士兵胸部装甲遭受了一次近距离 5.56 毫米突击步枪射击。士兵最初报告胸骨区域有轻度疼痛，评估显示有 4cm×3cm 的皮肤擦伤。在急诊室评估后，士兵被诊断为胸骨体的无移位横断骨折。在第二个病例中，一名 20 岁的男性士兵被五发机枪子弹（7.62 毫米）击中他的体装甲。胸部 CT 显示右下叶和中叶的肺挫伤。两名士兵都在数周内完全康复并返回战斗岗位。这些病例突出了高能射弹撞击体装甲时能量传递的潜在风险，前线医务人员需要意识到潜在的钝性损伤风险。进一步报告使用高速射弹的临床病例和模型研究，可以为 BABT 患者的分诊、疏散和评估提供建议。
