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2A84
Institute Report No. 239, What's Wrong with the Wound Ballistics Literature, and Why
12.PERSONAL AUTHOR(S)
M.L. Fackler,
M.D.
I3b. TIME COVERED
FROM I1R6TO ...
Institute Report
R7L
15SPAGE COUNT
33
1987 jl
COSATI CODES
17.
-- FELD
GROUP
k -4
SUB-GROU
Kinetic Energy.-
Martin L. Fackler
DD FORM 1473. 84 MAR
0 OTIC USERS
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ABSTRACT
Attempts to explain wound ballistic3 (the study of
effects on the body produced by penetrating projctiles)
Fallacious recearch by
have succeeded in mystifying it.
grasp of the fundamentals has been
those with little
perpetuated by editors, reviewers, and other' investigators
This report explains
with no better grasp of the subject.
the projectile-tissue interaction and presents data
showing the location of tissue disrupted by various
These tissue disruption data are prasented
proj&ctiles.
The major misconceptions
in the form of wound profiles.
perpetuated in the field are listed, analyzed, and their
errors exposed using wound profiles and other known data.
The more serious consequences of thesa misconceptions are
Vailure in adhering to the basic precepts of
discussed.
Aes;0O' For
NTIS CRAWI
TAB
OTIC
[I
Ulannouriced
oJustificatton .f.. ...
By......................
Di-AIItbutor I
Availablity Codes
Dl-t
INSPECEI
Fackler--l
Undoubtedly,I
h~~maIv
aia-V
rackler--2
pip being shot through the abdomen vlth an M-16 rifle that
"made the rounds' about fifteen years ago.
No scale or
any other item was included to provide size orientation.
How large was the pig? Most would assume the animal to be
in the 100- to 150-kg range.
It was actually a mini-pig,
weighing about one tenth that much.
The exaggeration of
effects so introduced is obvious.
THE WOUND PROFILE - UNDERSTANDING THE PROJECTIILB-TISSUE
INTERACTION
A projectile crushes the tissue it strikes during
penetration, and it may impel the surrounding tissue
outward (centrifugally) away from the missile path.
Tissue crush is responsible for what is commonly called
the permanent cavity and tissue stretch is responsible for
the so-called temporary cavity. These are the sole
wounding mechanisms.
In addition, a sonic pressure wave
is 9nerated by projectiles traveling faster than the
speed of sound.
In air this wave trails the projectile
like the wake of a ship. The sonic boom experienced after
passage of a supersonic airplane is an example of a sonic
pressure wave.
This pressure wave travels at the speed of
sound in the mudium through which it passes, and sound
travels four times as fast through tissue as it does
through air. Thus the sonic wave pr.cedes the projectile
in tissue.
Contrary to popular opinion (3, 30),
this
wave does not move or iniure tissue.
Harvey's exhaustive
experiments during WW I: showed clearly the benignity of
the sonic pressure wave :31).
The lithotripter, a recent
invention that uses this sonic pressure wave to break up
kidney stones, generates a wave five times the amplitude
of the one from a penetrating small arms projectile. Up
to 2,000 of these waves are used in a single treatment
session, with no damage to soft tissue surrounding the
stone (32,33).
It would be difficult to imagine more
convincing confirmation of Harvey's conclusions.
The wound produced by a particular penetrating
projectile is characterized by the amount and location of
tissue crush and stretch.
In our laboratory, we measure
the amount and location of crush (permanent cavity) and
stretch (temporary cavity) on the basis of shots fired
into gelatin tissue simulant.
Since we have calibrated
this simulant to reproduce the projectile characteristics
(penetration depth, deformation, fragmentation, yaw)
equivalent to those observed in living animal tissue,
Fnkler--3
S-V"
Fackler--4
disruption.
Despite this recent evidence, a generation of
surgeons and weapon developers (28) has been confused and
prejudiced by the assumption that "high velocity" and
wtemporary cavitationw were the sole causes of tissue
disruption.
It is indeed surprising that only Lindsey questioned
the attribution of the marked increase in tissue
disruption to a rather modest 10% increase in velocity.
Surely, someone should have noticed that the largest
increase of projectile velocity in the history of smallarms development (a 50% increase--made possible by the
invention of the copper-jacketed bullet near the end of
the nineteenth century) was accompanied by a marked
dereas in soft tissue disruption (51, 52).
This
decrease was predicted by Kocher, whose work had taught
him the importance of projectile deformation (26, 27); new
smaller-caliber bullets did not deform upon striking
tissue as did previous large caliber soft lead bullets
(Fig 1).
2. Exaggeration of Temporary Cavity Size, Pressure,
Effect,-
and
Fackler--5
Fackler--6
It
alone (59).
3.
Asaumption of Bullet
Tumbling" in
Flight:
studies
(10,
13,
velocity.
Fackler--7
,I
~1
Vackler--S
Fackler--9
67,
68).
In a study of over
Fackler--10
Fackler--ll
(deformation,
fragmentation),
damage.
Fackler--12
Fackler--13
(78).
Fackler--14
Fackler--15
DISCUSSION
Violation of simple, fundamental scientific method
common thread that runs through the
aTppears to be the
dealt with in this review. The author has
misconceptions
found verifiable validity in only a small percentage of
the material in print. The field of wound ballistics is
part physics and part biological science. Considering the
large proportion of "exact* science in wound ballistics,
we should expect to produce a literature with more
validity and reproducibility than other medical or
"inexact" fields. Quite the opposite appears to have
taken place. Failure to consider all the variables in the
missile-tissue interaction, failure to use a control
animal, failure to calibrate tissue simulants, failure to
require data to support assumptions, etc.--these were the
Facklor--16
Fackler--17
AK.OWLEDGDM4NTS
The author wishes tc acknowledge the
advice and assistance of John D. O'Benar, PhD, and Charles
Z. Wade, PhD, of the Military Trauma Research Division,
and John P. Hannon, PhD, Scientific Advisor of the
Letterman Army Institute of Research, in arranging the
data and expressing the thoughts contained in this paper.
He also wishes to express appreciation to Paul J.
Dougherty, Senior Medical Student at the Uniformed
Services University of the Health Sciences Medical School,
for his contribution of valuable literature references
previously unknown to the author.
"I
Fackler--18
RIFERUNCES
1.
2.
Swan KG, Swan RC, Levine MG, Rocko 3M: The US M-16
rifle
versus the Russian AK-47 rifle.
?.J Sura
1983;49:472-479.
3.
Ordog GJ,
4.
5.
Wasserberger J,
Balasubramanium S:
Emera KO 1964;13:1113-1122.
Ann
7.
Swan KG:
Missile injuries:
principles of management.
Mili
Ned 1987;152:29-34.
8.
9.
10.
11.
12.
13.
Fackler ML:
Wound ballistics,
~~
~ ~
-~~jm
N
Z
J
U
O
A', A~WR
. M~kJR-A
K I
&ALILA
Fackler- -19
AmSr
1986; 31:801-802.I
18. tackler ML: Letter to the editor.
1906; 9:1336.
Qxth2pdig
(ii
23. Kocher T: Uwber 41. Sprengvirkung der Modernen Kleingevel6r'-geschosse. Ccorresgpondena-Blatt fuer Schweitzer
Ai':.= 3,875;5:3-7, 29-33, 69-74.
24. Kocher T: Neue Beitraege zur Kenntnis der
Wlikungsweise der Modernen Klein-gewehr-geschosse.
en-Blatt fuer Schweitzer Aerzte17;65
Qz~ar
25. Kocher Tt tWeler Schusswunden. '.x erimentelle
Untersuchungen ueber ale Wirkun(3sseise der Modernen
xltin-gewehr-geschosse.. Leipzig, Verlag von FCW
Vo~ial, 1880.
26. Kocher T: Die Verbesserung der Geschosse von
Fackler--20
llth international
Stangpunktt der umainitaet.
29 March-5 April, 1891; 1
Nedicsi Congress, Roe.
Parts GJenerale 32C-32b.
27.
Kocher Tt
nAnShsyns
zrLh&
"c
S. Ceasel,
1095.
.G.
28.
29.
30.
Ragsdale BD:
perspective.
31.
32.
33.
34.
35.
36.
Gunshot wounds:
A historical
Milit Ned 1984;149:301-315.
Gunshot Wounds:
Littleton, Mass,
Baltimore,
London,
Pathophvsiologv
PSG Publishing Co
Fackler--21
1980, pp 7-15.
38. Orlowski T, Piecuch T, Domani~cki J, badowski A:
Mechanisms of development of shot wounds caused by
missiles of different initial velocity. A
EcaM 1982;suppl 508a123-127.
39.
Litvin NS:
injured
40.
Christoe
D Sa
Trauma:
chap 19.
TLY.U
Philadelphia,
Lov-velocity
1980;20:1061-
Trajet
tN
?ackler--22
lesionnel
'Wound Profileset
vasomotricite cutanee.
in yravguz ouasientifioues
dep Chercheurs ft S 1 A
"1 n X
1"8.
Direction Central* de Ser*vice de
Sante deo Armee, Paris, Republique Francaise Ministre
de la Defense, 1987.
49. Dimond FC Jr, Rich kM: 1-16 rifle wounds in Vietnam.
J Tra=m 1967;7:6l9-625.
50. Dudle MAP, Knight R3, RWceut JC, Rosengarten DS:
IrJ
Civilian battle casualtigs in South Vietnam.
I = 1968;55:332-340.
51. LaGarde LA:
53.
Amato JJ, Rich NX, Billy LJ, Gruber RP, Lawson NS:
High-velocity arterial injury: A study of the
mechanism of injury. J Trauma 1971;11:412-416.
54.
Belkin M:
55.
56.
57.
58.
59.
Wound ballistics.
Fackler--23
Firearm injuries.
DrJ
65.
Ziervogel 3F:
7.62 NATO rifle.
135.
69.
70.
---------
Fackler--24
71.
72.
73.
Gun
in Warner K (ed):
Int
76.
77.
Humphreville M:
78.
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