Arslan Ilknur, Öğünç Gökhan İbrahim, Pazarcı Özhan, Hilal Ahmet, Eryılmaz Mehmet
Adana City Training and Research Hospital, Pediatric Intensive Care Unit, Adana-Türkiye.
Department of Criminalistics, Gendarmerie and Coast Guard Academy, Institute of Forensic Sciences, Ankara-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2025 Jun;31(6):516-524. doi: 10.14744/tjtes.2025.12472.
Gunshot wounds are the second leading cause of life-threatening injuries and frequently affect the extremities, accounting for 63% of combat-related cases over the past 50 years. Although extremity injuries have lower mortality rates, they still require urgent treatment to reduce complications. Wound ballistics studies often use tissue surrogates like ballistic wax and gelatin, which have limitations due to their dissimilarity to living tissues. There is insufficient data on the effects of gunshots on extremities composed of bone and muscle, which differ in resistance and elasticity. This study aims to analyze the damage caused by commonly used ammunition in living tissue and provide healthcare professionals with critical insights to improve emergency care.
The study involved six Adana-breed sheep, aged 3-4 years, previously used in another study and showing no vital signs. Ethical approval was obtained from the local ethics committee. Test shots were conducted using 9×19 mm (M822), 5.56×45 mm (SS109), and 7.62×51 mm (M80) bullets from a distance of 300 cm, targeting the front legs of sheep positioned laterally. Following the shots, entry and exit wounds were photographed, and anteroposterior and lateral X-ray images of the extremities were taken for analysis. The aim was to examine the effects of different types of ammunition on extremities and provide insights into the characteristics of gunshot wounds.
In the first test group (subjects A and B), X-ray imaging revealed joint integrity loss, multi-part fractures, and cavitation in the soft tissue, with bone fragments distributed along the exit trajectory. No bullet fragments were found within the wound cavity. The M822 bullet produced a typical entry wound and a smaller, more defined exit wound. In the second group (subjects C and D), SS109 bullets caused fragmentation of bone, muscle, tendon, and skin. Bullet fragments created a shrapnel-like effect. The exit wounds were larger and had irregular edges. In the third group (subjects E and F), M80 bullets caused extensive tissue disruption due to their high kinetic energy. The resulting exit wounds were wide and irregular.
This study found that M80 bullets caused the most severe bone and soft tissue damage compared to M822 and SS109 bullets, primarily due to their higher kinetic energy density and structural characteristics. Unlike prior research using synthetic tissue models, this study demonstrates the real-tissue effects of different ammunition types. Radiologists, forensic medicine experts, and other healthcare professionals should be aware that firearm injuries vary depending on the bullet's characteristics. Applying this understanding can lead to appropriate diagnoses and improved treatment strategies, ultimately enhancing patient outcomes.
枪伤是危及生命的损伤的第二大主要原因，并且经常累及四肢，在过去50年中占与战斗相关病例的63%。尽管四肢损伤的死亡率较低，但仍需要紧急治疗以减少并发症。创伤弹道学研究通常使用弹道蜡和明胶等组织替代物，由于它们与活体组织不同，存在局限性。关于枪击对由骨骼和肌肉组成的四肢的影响的数据不足，骨骼和肌肉在阻力和弹性方面存在差异。本研究旨在分析常用弹药在活体组织中造成的损伤，并为医疗保健专业人员提供关键见解，以改善急诊护理。
该研究涉及6只阿达纳品种的绵羊，年龄在3至4岁之间，之前用于另一项研究且已无生命体征。获得了当地伦理委员会的伦理批准。使用9×19毫米（M822）、5.56×45毫米（SS109）和7.62×51毫米（M80）子弹，从300厘米的距离进行测试射击，目标是侧卧的绵羊的前腿。射击后，拍摄进出伤口的照片，并拍摄四肢的前后位和侧位X线图像进行分析。目的是研究不同类型弹药对四肢的影响，并深入了解枪伤的特征。
在第一测试组（受试者A和B）中，X线成像显示关节完整性丧失、多处骨折以及软组织内有空化现象，骨碎片沿出口轨迹分布。伤口腔内未发现子弹碎片。M822子弹造成典型的入口伤口和较小、更清晰的出口伤口。在第二组（受试者C和D）中，SS109子弹导致骨骼、肌肉、肌腱和皮肤破碎。子弹碎片产生了类似弹片的效果。出口伤口更大且边缘不规则。在第三组（受试者E和F）中，M80子弹因其高动能导致广泛的组织破坏。产生的出口伤口宽阔且不规则。
本研究发现，与M822和SS109子弹相比，M80子弹造成的骨骼和软组织损伤最严重，主要是由于其更高的动能密度和结构特征。与之前使用合成组织模型的研究不同，本研究展示了不同类型弹药对真实组织的影响。放射科医生、法医学专家和其他医疗保健专业人员应意识到，火器伤因子弹特征而异。应用这一认识可导致适当的诊断和改进的治疗策略，最终改善患者预后。
