S-Cl2
Ballistics and mechanisms of tissue wounding
Laith A. Farjo, M.D., Theodore Miclau, M.D.
Department of Orthopaedic Surgery, University of California,
San Francisco, California, U.S.A.
Summary’
The wounding potential and mechanisms of tissue dam-
age of firearms are reviewed. Internal ballistics is the
study of projectile flight within a firearm while external
ballistics describes projectile flight through air to the tar-
get. Terminal ballistics characterizes the final effects of
the bullet after it has impacted its target. Upon impact,
three tissue phenomena are noted: sonic wave forma-
tion, temporary cavitation, and permanent cavitation.
Subsequent tissue damage is dependent on the charac-
teristics of the firearm that fired the projectile (e.g. rifle
versus handgun), the nature of the projectile itself (e.g.
fully jacketed versus expanding bullet), and the attrib-
utes of the target tissue (e.g. tissue elasticity).
Keywords: ballistics, firearms, bullets, gunshot
wounds
Introduction
Ballistics is the study of the firing, flight, and effects of
projectiles. It may be classified into three subgroups: in-
ternal ballistics, or the study of projectile firing; exter-
nal ballistics, or the description of projectile flight; and
terminal ballistics, or the science of the projectile effect
on the target. There are many variables that describe the
wounding potential of firearms, including weapon type
and design, bullet type, and target tissue characteristics.
1 Abstracts in German, French, Italian, Spanish and Japanese
are printed at the end of this supplement.
San Francisco, San Francisco General Hospital,
Internal ballistics
Internal ballistics describes projectile flight within the
weapon. Despite advances in bullet design and the in-
troduction of more powerful and fully automatic
weapons, firearms continue to operate on long-estab-
lished principles (1). The firearm is loaded with a car-
tridge that contains explosive primer, gunpowder, and
the bullet. After the trigger is released, it drives a firing
pin into the cartridge which contains the primer at its
base. The spark created by this process ignites the gun-
powder, which then propels the bullet down the barrel.
During its path in the barrel of the weapon, the bullet
begins to spin as it traverses grooves machined into the
barrel. These grooves are termed the ‘rifling’ of the
weapon.
There are three basic determinants of the exit veloci-
ty of the bullet. The first determinant is the mass of the
bullet: the greater the bullet’s mass, the harder it is to
propel with the same amount of gunpowder (2). The
second determinant is the amount of gunpowder in the
cartridge: the larger the amount of gunpowder, the
greater the explosion. ‘Magnum’ versions of weapons
are those which utilize a bullet of the same size and
weight, but contain more gunpowder (3). The amount
of gunpowder placed in a cartridge is limited, howev-
er, to the strength of the barrel and the amount of recoil
produced (excessive recoil may make a weapon diffi-
cult to use) (4). The final determinant of muzzle or exit
velocity is the length of the barrel. As soon as the bullet
exits the firearm, the gaseous pressure that propelled it
forward quickly dissipates. The bullet then decelerates
as it faces the effects of atmospheric drag (1). This is one
of the reasons that rifles, with their longer barrels, are
able to attain significantly higher velocities than hand-
guns.
Favjo and Miclau: Ballistics and tissue wounding
External ballistics
External ballistics describes the flight of the projectile
through the atmosphere as it travels towards its target.
In this phase, the bullet is in a state of deceleration due
to the drag effect of the atmosphere. The amount of drag
in air is directly related to bullet speed; faster bullets are
retarded proportionally more than slower bullets (2).
The spin imparted by the rifling of the barrel helps to
stabilize the bullet during its course. Heavier bullets
tend to be more stable in flight (1). In addition, the bul-
let undergoes several complex motions during its path.
‘Yaw’, describing the angle of the long axis of the bullet
with respect to its flight path, occurs as the bullet rocks
back and forth on its centre of gravity (Fig. 1) (5). In air,
the yaw angle is only l-3 degrees (6). Yaw becomes more
significant once the target is struck.
Terminal ballistics and tissue wounding
One of the classical determinants of tissue wounding is
the release of kinetic energy to the target (4). Kinetic en-
ergy (KE) is defined as
KE = MV2
where M = mass and V = velocity. The total energy
released to the target can therefore be represented by
A KE = KEentry- KEexit
From this formula, it is evident that a higher entry KE
(e.g. by increasing bullet mass or velocity) has a higher
potential for wounding (7). However, if the exit kinetic
energy is still high, then relatively minor tissue damage
may result. For example, a bullet that passes cleanly
through the target and exits with a significant velocity
will not cause as much damage as a bullet with similar
entry kinetic energy that completely decelerates and
comes to rest within the target (8). In addition, projec-
tiles with a higher impact velocity have a greater drag
within the tissues, and hence have a greater A KE (1).
Fig. 1: Yaw is the angle between the long axis of the bullet and its path of flight. In this figure, the yaw angle is
exaggerated for illustrative purposes. It typically averages 1-3 degrees for most bullets travelling through air (6).
Injury 1997, Vol. 28, Suppl. 3
S-Cl3
It should be noted, however, that transfer of kinetic
energy is not the singular determinant of tissue wound-
ing. Interactions between the projectile and tissue play
a major role in influencing the resultant amount of de-
struction (6). Three tissue phenomena are noted when
the target is struck: 1) sonic pressure waves, 2) perma-
nent cavity formation, and 3) temporary cavitation
(Fig. 2) (1,5,6,9-11).
Sonic waves
A sonic pressure wave, travelling at approximately 4800
feet/second (the speed of sound in water), precedes the
projectile following impact (9,12). Harvey, in a series of
elegant experiments performed in 1947, showed that
these pressure waves, although producing pressures up
to 117 atmospheres, lasted only a few microseconds. He
was able to isolate the sonic pressure wave from the tem-
porary and permanent cavity effects and show that it
did not have any significant disruption capacity on tis-
sue, including beating frog hearts (9). Indeed, modern
lithotriptors produce stronger sonic pulses without any
significant soft tissue effects (11). Recently, investigators
have re-examined the issue of sonic wave contribution
to wounding, demonstrating that sonic waves may con-
tribute to the disruption of neural function, even at sites
of the body distant to that impacted by the bullet (13-
16). However, their data has been criticized because they
failed to completely isolate the effects of the sonic wave
from the temporary cavity (11).
Permanent cavity
The permanent cavity produced by bullet entry consists
of that tissue which is crushed by the bullet. Fackler et
al. have demonstrated that different firearms can pro-
duce markedly different permanent cavities depending
on the interaction of the bullet with the tissues (Fig. 3)
(6,lO). His experiments were performed by firing vari-
ous weapons into gelatin blocks and then examining the
Line of
Yaw angle 2
 S-Cl4

target significantly increases the destructive capacity of

---_-./”. Sonic Wave the projectile. As the bullet yaws within the target tis-
Temporary Cavity sue, it increases its effective diameter, with a maximum
---___ reached at 90 degrees of yaw, This explains why a de-
--%._
-% ceptively small entrance wound can coexist with mas-
sive internal damage. Different bullets yaw at different
tissue depths; for example, faster, more stable bullets
tend to yaw deeper into the target (1).
The ratio of bullet size to velocity also influences tis-
sue effects. A large, relatively slow projectile tends to
crush tissue in its path with little radial dispersion of
Permanent High
Cavity Pressure
energy (temporary cavity formation). A small, fast bul-
Zone let, on the other hand, tends to crush little tissue and cre-
ate more transient radial tissue stretching (6). Because
Fig. 2: Tissue pressure phenomena caused by bullet en- of these phenomena, it is evident that two bullets of sim-
try. All of the illustrated effects are variable, depending ilar kinetic energy can have markedly different wound-
on tissue characteristics and bullet mass, velocity, and ing potentials. Bullet deformation and fragmentation
deformation. The sonic wave precedes the bullet at the are significant contributors to permanent cavity forma-
speed of sound in tissue at approximately 4800 feet/set- tion. Bullet design has a major influence on these effects
ond. A localized area of high pressure is noted at the bul- and will be discussed below.
let tip (9). The temporary cavity expands radially out-
ward behind the bullet and the permanent cavity is the
tissue that has been crushed by the bullet. Temporary cavity

The temporary cavity is caused by the release of ener-

resultant damage. The volume of the permanent cavity
was shown to be influenced by several factors.
As the projectile strikes its target, the stabilization ef-
fect of its spin is quickly overcome by the density of the
tissue. The bullet can yaw to 90 degrees and often may
come to rest at a 180 degree angle to its initial path (1).
The yaw growth in the target is directly related to the
yaw at entry (17). This process of tumbling within the
gy into structures adjacent to the bullet path causing a
radial stretch of these tissues. The cavity is created be-
hind the path of the bullet, creating pressures between
4 atmospheres and subatmospheric pressure (9). The
size of this cavity can be up to 30 times the volume of
the missile (6).
The effect of the temporary cavitation will depend on
the elasticity of the tissue struck. Highly elastic tissue

I -
I ?A32 mm NATO
Vet-2830
Wt-15Ogr
fh, (ES2 mts)
(0.72m) FMC

Psrmenent Csvity

Fig. 3: Wound profile (lo), created by firing a 7.62 mm NATO full metal jacketed bullet at 2830 feet/second into or-
dinance gelatin. Note the yaw of the bullet to 90 degrees in tissue, then coming to rest at 180 degrees to its entry path.
This tumbling markedly increases the dimension of the permanent cavity. Another factor in wounding is that the
depth of maximal yaw, 28 cm in this case, may occur after the bullet has already passed through a thin target, such
as a human body struck directly anteriorly, or a limb. Also note the radial expansion of the temporary cavity around
the bullet path.
Favjo and Miclau: Ballistics and tissue wounding
such as lung will easily accommodate the stretching cre-
ated by the temporary cavity. Other, less elastic struc-
tures, such as liver, or a structure contained by an in-
elastic tissue, such as the brain, may be seriously dam-
aged by this wave. Investigators have shown that a tem-
porary cavity produced in close proximity to bone can
cause it to shatter and propel many ‘secondary missiles’,
thereby increasing tissue damage in a fashion similar to
the permanent cavity (18).
Due to the variability of damage secondary to the tem-
porary cavity, clinical judgment must be utilized in de-
termining the actual extent of tissue damage. For the
most part, the surgeon should concentrate on tissues
that are clearly not viable and perform a re-exploration
of the tissues that may have been injured by secondary
effects. Certainly, with the often massive size of the tem-
porary cavity produced by modern day firearms, exci-
sion of the entire cavity is not only unwarranted, but
also is often impossible (19).
Firearm types
There are three basic types of firearms: rifles, handguns,
and shotguns. Rifles are the most powerful and are
known for their longer barrels and higher velocities
when compared to handguns. While great emphasis has
been placed on the classification of a weapon as high or
Bullet
Fig. 4: Wound profile of a soft-point version of the 7.62 mm NATO bullet shown in Figure 3, fired at a similar ve-
locity (10). Note the massive increase in permanent cavity formation caused by bullet deformation and fragmenta-
tion. The maximum dimension of this cavity is also formed much closer to the surface, 14 cm versus 28 cm, than the
fully jacketed bullet.
Injury 1997, Vol. 28, Suppl. 3
S-Cl5
low velocity, the distinction is quite vague, with values
ranging from 1100 to 2500 feet/second (2, 11). Most
rifles generate muzzle velocities greater than 2500
feet/second. These high energy weapons are designed
to be held with both arms, thereby increasing their tol-
erable recoil energy limit. An M-16 military rifle, for ex-
ample, generates a velocity of 3,240 feet/second for a 55
grain bullet (20). Rifles have increased wounding pow-
er, increased accuracy at long distances, and the capac-
ity for high speed automatic fire. These benefits are at
the expense of difficulty in concealment because of in-
creased weight and size and increased recoil which
makes them harder to shoot.
Handguns are the least powerful of the firearms. Be-
cause of their shorter barrels, they have decreased ve-
locity, kinetic energy, and accuracy when compared to
rifles. Typically, the maximum velocity attainable is ap-
proximately 1,500 feet/second (20). ‘Caliber’ refers to
the diameter of the bullet, in thousandths of an inch.
Hence, a ‘.357 magnum’ fires a 0.357 inch diameter pro-
jectile at 1450 feet/second, a higher velocity than a stan-
dard .357 handgun. Handguns are available in two main
designs - revolvers and pistols. Revolvers have a cylin-
der which usually holds six cartridges and requires re-
peated pulling of the trigger to fire the weapon - the
hammer is cocked either manually (single action) or au-
tomatically by pulling the trigger (double action). Au-
tomatic pistols contain a magazine of cartridges which
hatlmsnts
Parmsnsnt Cavity 7.02mm SP
vel - 2922 t/s (891 mfa)
wt-tsogr (wgmj
Flnal wt -02.7 gr (5.M am)
98.4% fragmentation
‘
cm
mporaty Cevtty

typically holds 9 to 19 rounds and can be fired by re-
peatedly pulling the trigger. Handguns are favored in
urban warfare because they are easily concealed and are
effective at short ranges; most shootings occur within
7 yards of the target person (20).
Shotguns, depending on the range from the target and
the size of the pellets fired, may cause minor to massive
damage. A shotgun shell consists of a cylinder with
primer and gunpowder at its base. The projectile por-
tion of the shell, the pellets, are separated from the gun-
powder by plastic or cardboard wadding. This wadding
can frequently be found in wounds inflicted at short
range. Shotguns are classified by ‘gauge’, which indi-
cates the weight of the pellets fired by the weapon in
fractions of a pound. For example, a 12-gauge shotgun
shoots pellets that weigh 1/12th of a pound each. The
barrel of a shotgun is smooth and is constricted by a
‘choke’ on the muzzle which narrows the exit diameter
and therefore helps decrease the spread of the pellets in
flight. ‘Sawing off’ the end of the shotgun serves both
to increase the spread of the shotgun pellets for use in
close-range combat and to make the weapon easier to
conceal (21).
Bullet design
As noted above, bullet interaction with tissue plays a
major role in determining the wounding capacity of any
given firearm. Military bullet design is governed by the
Hague Convention of 1899 which mandated that these
bullets be surrounded by a full metal jacket (1). This jack-
eting consists of a hard metallic outer coating, such as
copper, which surrounds the softer inner bullet which
consists of lead. This allows for higher weapon veloci-
ties, since unjacketed lead cannot be fired faster than
2000 feet/second because of stripping of the lead with-
in the barrel of the gun (5). Because of the jacketing, these
bullets will not fragment in tissue as much as an un-
jacketed bullet. Bullets available to civilians, however,
do not have to be jacketed. Because bullet fragmenta-
tion can have a significant adverse effect on tissue, it is
often quite possible to see much more devastating
wounds with weapons fired from civilian firearms
(Fig. 4).
Bullet manufacturers have introduced new bullet de-
signs which are designed to either deform or fragment
within the target. These designs provide maximum de-
liverance of kinetic energy and increase in the size of the
permanent cavity. Hollow-point bullets expand to dou-
ble the bullet diameter on impact (22, 23). Shot shells
such as the ‘Glasser Safety Slug’ contain pellets in the
bullet tip which disintegrate upon impact. Bullets such
as the ‘Devastator’ (utilized in the President Reagan
assassination attempt) explode upon impact and can
produce massive internal damage. The Safety Slug and
Devastator were developed for use by law enforcement
S-Cl6
officials in situations where innocent bystanders near
the target victim may be endangered by passing of the
bullet through the intended target. Little is known about
the risk of in-vivo retention of undetonated exploding
bullets; however, extreme care must be taken during
their removal because simple manipulation can cause
them to detonate (22).
Concluding remarks
The primary factors in tissue wounding include the
amount of kinetic energy delivered to the subject and
tissue-bullet interaction. Sonic waves produced by pro-
jectile impact do not significantly affect most organ sys-
tems. The size of the permanent cavity produced, which
is the most significant component of tissue damage, de-
pends on bullet energy, tumbling, expansion, and frag-
mentation within the target. The temporary cavity pro-
duced by bullet impact can be large, but for most elas-
tic tissues causes only minor damage.
Of the three basic firearms, rifles have the greatest
wounding capacity at long distances. Shotguns are ca-
pable of producing massive wounds at close ranges.
Handguns, particularly with the advent of deforming
and fragmenting bullets, can also induce massive
wounding and can be easily concealed.
Future research in ballistics will include the mathe-
matical and statistical modelling of bullet flight and tis-
sue damage, the characterization of the true injury
caused by the temporary cavity and sonic waves, the
further study of alternative projectile systems (such as
fragmentation devices), the definition of the biological
response to projectile wounding, and the continued
evaluation of the newest available firearms in modern
day civilian and military warfare (17,24,25).
References
1. Barach E, Tomlanovich M, Nowak R. Ballistics: a patho-
physiologic examination of the wounding mechanisms of
firearms: Part I. J. Trauma 1986;26:225-35.
2. DeMuth WE, Jr. Bullet velocity as applied to military rifle
wounding capacity. J. Trauma 1969;9:27-38.
3. DeMuth WE, Jr. Ballistic characteristics of ‘magnum’
sidearm bullets. J Trauma 1974;14:227-9.
4. DeMuth WE, Jr. Bullet velocity and design as determinants
of wounding capability: an experimental study. J. Trauma
1966;6:222-32.
5. Hollerman JJ, Fackler ML, Coldwell DM, Ben-MenachemY.
Gunshot wounds: 1. Bullets, ballistics, and mechanisms of
injury. Am. J. Roentgenol; 1990;155:685-90.
6. Fackler ML. Wound ballistics. A review of common mis-
conceptions JAMA 1988;259:2730-6 [published erratum
appears in JAMA 1988 9;260(22): 32791.
Farjo and Miclau: Ballistics and tissue wounding S-Cl7

Cheng XY, Feng TS, Liu YQ, et al. Wounding properties of 25. Peters CE, Sebourn CL. Wound ballistics of unstable pro-
steel pellets with different velocities and quality on soft tis- jectiles. Part II: temporary cavity formation and tissue
sue of dogs. J. Trauma 1988;28:S33-6. damage. J. Trauma 1996;4O:S16-21.
Swan KG, Swan RC. Principles of ballistics applicable to
the treatment of gunshot wounds. Surg. Clin. North Am. Address for correspondence:
1991;71:221-39.
Theodore Miclau, M.D., San Francisco General Hospi-
Harvey E, Korr I, Oster G, McMillen J. Secondary damage tal, 1001 Potrero Avenue, 3A36, San Francisco, CA94110
in wounding due to pressure changes accompanying the
USA
passage of high velocity missiles. Surgery 1947;21:
218-239.
10. Fackler ML, Bellamy RF, Malinowski JA. The wound pro-
file: illustration of the missile-tissue interaction. J. Trauma
1988;28:S21-9.
11. Fackler ML. Gunshot wound review. Ann. Emerg. Med.
1996;28:194-203.
12. Harvey E, McMillen J. An experimental study of shock
waves resulting from the impact of high velocity missiles
on animal tissues. J. Exp. Med. 1947;85:321-328.
13. Suneson A, Hansson HA, Kjellstrom BT, Lycke E, Seeman T.
Pressure waves caused by high-energy missiles impair res-
piration of cultured dorsal root ganglion cells. J. Trauma
1990;30:484-8.
14. Suneson A, Hansson HA, Seeman T. Peripheral high-
energy missile hits cause pressure changes and damage to
the nervous system: experimental studies on pigs. J. Trau-
ma 1987;27:782-9.
15. Suneson A, Hansson HA, SeemanT. Pressure wave injuries
to the nervous system caused by high-energy missile ex-
tremity impact: Part I. Local and distant effects on the pe-
ripheralnervous system- a light and electron microscopic
study on pigs. J. Trauma 1990;30:281-94.
16. Suneson A, Hansson HA, Lycke E, Seeman T. Pressure
wave injuries to rat dorsal root ganglion cells in culture
caused by high-energy missiles. J. Trauma 1989;29:10-8.
17. Peters CE, Sebourn CL, Crowder HL. Wound ballistics of
unstable projectiles. Part I: projectile yaw growth and re-
tardation. J. Trauma 1996;4O:SlO-5.
18. Amato JJ, Syracuse D, Seaver PR, Jr., Rich N. Bone as a sec-
ondary missile: an experimental study in the fragmenting
of bone by high-velocity missiles. J. Trauma 1989;29:609-
12.
19. Fackler ML. Wound ballistics: the management of assault
rifle injuries Mil. Med; 1990;155:222-5 [published erratum
appears in Mil. Med. 1990;155(9):A13].
20. Barach E, Tomlanovich M, Nowak R. Ballistics: a patho-
physiologic examination of the wounding mechanisms of
firearms: Part II. J. Trauma 1986;26:374-83.
21. Ordog GJ, Wasserberger J, Balasubramaniam S. Shotgun
wound ballistics. J. Trauma 1988;28:624-31.
22. Sykes LN, Jr., Champion HR, Fouty WJ. Dum-dums, hol-
low-points, and devastators: techniques designed to in-
crease wounding potential of bullets. J. Trauma 1988;
28:618-23.
23. Berlin RH, Janzon B, Liden E, et al. Terminal behaviour of
deforming bullets. J. Trauma 1988;28:S58-62.
24. Wang Z. The past, present, and future of wound ballistics
research in China. J. Trauma 1996;4O:S46-9.

Injury 1997, Vol. 28, Suppl. 3