Clinical update: gunshot wound ballistics.

摘要: Although firearm related injury and mortality actually may be declining, gunshot trauma remains a significant cause of morbidity socioeconomic cost with 115,000 missile injuries annually as many 40,000 deaths. Wounds typically are classified low-velocity ( 2000 feet/second). However, these terms can misleading. More important is the efficiency energy transfer, which dependent on projectile's physical characteristics including deformation fragmentation, kinetic energy, stability, entrance profile, path traveled through body, biologic tissues. Therefore, decision whether to explore wound should not based solely involvement high-velocity or weapon. The majority wounds treated safely nonoperatively local care outpatient treatment. Treatment associated fractures generally dictated by bony injuries, have similar personalities closed fractures. Because contamination always apparent, routine antibiotic prophylaxis still recommended. soft tissues assume more crucial role in shotgun fractures, whereas high-energy grossly contaminated mandate irrigation, appropriate debridement, use open fracture protocols. patient limited tissue disruption, no functional deficits, evidence bullet minimal candidate for simple care. When exploration indicated, decompression excision necrotic rule color, consistency, contractility, capacity bleed providing valuable information regarding muscle viability.