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Ballistics and mechanisms of tissue wounding

Laith A. Farjo, M.D., Theodore Miclau, M.D.

Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco General Hospital,
San Francisco, California, U.S.A.

Summary’ Internal ballistics

The wounding potential and mechanisms of tissue dam- Internal ballistics describes projectile flight within the
age of firearms are reviewed. Internal ballistics is the weapon. Despite advances in bullet design and the in-
study of projectile flight within a firearm while external troduction of more powerful and fully automatic
ballistics describes projectile flight through air to the tar- weapons, firearms continue to operate on long-estab-
get. Terminal ballistics characterizes the final effects of lished principles (1). The firearm is loaded with a car-
the bullet after it has impacted its target. Upon impact, tridge that contains explosive primer, gunpowder, and
three tissue phenomena are noted: sonic wave forma- the bullet. After the trigger is released, it drives a firing
tion, temporary cavitation, and permanent cavitation. pin into the cartridge which contains the primer at its
Subsequent tissue damage is dependent on the charac- base. The spark created by this process ignites the gun-
teristics of the firearm that fired the projectile (e.g. rifle powder, which then propels the bullet down the barrel.
versus handgun), the nature of the projectile itself (e.g. During its path in the barrel of the weapon, the bullet
fully jacketed versus expanding bullet), and the attrib- begins to spin as it traverses grooves machined into the
utes of the target tissue (e.g. tissue elasticity). barrel. These grooves are termed the ‘rifling’ of the
Keywords: ballistics, firearms, bullets, gunshot There are three basic determinants of the exit veloci-
wounds 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
Introduction cartridge: the larger the amount of gunpowder, the
greater the explosion. ‘Magnum’ versions of weapons
Ballistics is the study of the firing, flight, and effects of are those which utilize a bullet of the same size and
projectiles. It may be classified into three subgroups: in- weight, but contain more gunpowder (3). The amount
ternal ballistics, or the study of projectile firing; exter- of gunpowder placed in a cartridge is limited, howev-
nal ballistics, or the description of projectile flight; and er, to the strength of the barrel and the amount of recoil
terminal ballistics, or the science of the projectile effect produced (excessive recoil may make a weapon diffi-
on the target. There are many variables that describe the cult to use) (4). The final determinant of muzzle or exit
wounding potential of firearms, including weapon type velocity is the length of the barrel. As soon as the bullet
and design, bullet type, and target tissue characteristics. 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
1 Abstracts in German, French, Italian, Spanish and Japanese able to attain significantly higher velocities than hand-
are printed at the end of this supplement. guns.
Favjo and Miclau: Ballistics and tissue wounding S-Cl3

External ballistics It should be noted, however, that transfer of kinetic

energy is not the singular determinant of tissue wound-
External ballistics describes the flight of the projectile ing. Interactions between the projectile and tissue play
through the atmosphere as it travels towards its target. a major role in influencing the resultant amount of de-
In this phase, the bullet is in a state of deceleration due struction (6). Three tissue phenomena are noted when
to the drag effect of the atmosphere. The amount of drag the target is struck: 1) sonic pressure waves, 2) perma-
in air is directly related to bullet speed; faster bullets are nent cavity formation, and 3) temporary cavitation
retarded proportionally more than slower bullets (2). (Fig. 2) (1,5,6,9-11).
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- Sonic waves
let undergoes several complex motions during its path.
‘Yaw’, describing the angle of the long axis of the bullet A sonic pressure wave, travelling at approximately 4800
with respect to its flight path, occurs as the bullet rocks feet/second (the speed of sound in water), precedes the
back and forth on its centre of gravity (Fig. 1) (5). In air, projectile following impact (9,12). Harvey, in a series of
the yaw angle is only l-3 degrees (6). Yaw becomes more elegant experiments performed in 1947, showed that
significant once the target is struck. 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
Terminal ballistics and tissue wounding did not have any significant disruption capacity on tis-
sue, including beating frog hearts (9). Indeed, modern
One of the classical determinants of tissue wounding is lithotriptors produce stronger sonic pulses without any
the release of kinetic energy to the target (4). Kinetic en- significant soft tissue effects (11). Recently, investigators
ergy (KE) is defined as have re-examined the issue of sonic wave contribution
to wounding, demonstrating that sonic waves may con-
KE = MV2
tribute to the disruption of neural function, even at sites
where M = mass and V = velocity. The total energy of the body distant to that impacted by the bullet (13-
released to the target can therefore be represented by 16). However, their data has been criticized because they
failed to completely isolate the effects of the sonic wave
A KE = KEentry- KEexit
from the temporary cavity (11).
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 Permanent cavity
energy is still high, then relatively minor tissue damage
may result. For example, a bullet that passes cleanly The permanent cavity produced by bullet entry consists
through the target and exits with a significant velocity of that tissue which is crushed by the bullet. Fackler et
will not cause as much damage as a bullet with similar al. have demonstrated that different firearms can pro-
entry kinetic energy that completely decelerates and duce markedly different permanent cavities depending
comes to rest within the target (8). In addition, projec- on the interaction of the bullet with the tissues (Fig. 3)
tiles with a higher impact velocity have a greater drag (6,lO). His experiments were performed by firing vari-
within the tissues, and hence have a greater A KE (1). ous weapons into gelatin blocks and then examining the

Line of

Yaw angle 2
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

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

I -
I ?A32 mm NATO
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 S-Cl5

such as lung will easily accommodate the stretching cre- low velocity, the distinction is quite vague, with values
ated by the temporary cavity. Other, less elastic struc- ranging from 1100 to 2500 feet/second (2, 11). Most
tures, such as liver, or a structure contained by an in- rifles generate muzzle velocities greater than 2500
elastic tissue, such as the brain, may be seriously dam- feet/second. These high energy weapons are designed
aged by this wave. Investigators have shown that a tem- to be held with both arms, thereby increasing their tol-
porary cavity produced in close proximity to bone can erable recoil energy limit. An M-16 military rifle, for ex-
cause it to shatter and propel many ‘secondary missiles’, ample, generates a velocity of 3,240 feet/second for a 55
thereby increasing tissue damage in a fashion similar to grain bullet (20). Rifles have increased wounding pow-
the permanent cavity (18). er, increased accuracy at long distances, and the capac-
Due to the variability of damage secondary to the tem- ity for high speed automatic fire. These benefits are at
porary cavity, clinical judgment must be utilized in de- the expense of difficulty in concealment because of in-
termining the actual extent of tissue damage. For the creased weight and size and increased recoil which
most part, the surgeon should concentrate on tissues makes them harder to shoot.
that are clearly not viable and perform a re-exploration Handguns are the least powerful of the firearms. Be-
of the tissues that may have been injured by secondary cause of their shorter barrels, they have decreased ve-
effects. Certainly, with the often massive size of the tem- locity, kinetic energy, and accuracy when compared to
porary cavity produced by modern day firearms, exci- rifles. Typically, the maximum velocity attainable is ap-
sion of the entire cavity is not only unwarranted, but proximately 1,500 feet/second (20). ‘Caliber’ refers to
also is often impossible (19). 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-
Firearm types dard .357 handgun. Handguns are available in two main
designs - revolvers and pistols. Revolvers have a cylin-
There are three basic types of firearms: rifles, handguns, der which usually holds six cartridges and requires re-
and shotguns. Rifles are the most powerful and are peated pulling of the trigger to fire the weapon - the
known for their longer barrels and higher velocities hammer is cocked either manually (single action) or au-
when compared to handguns. While great emphasis has tomatically by pulling the trigger (double action). Au-
been placed on the classification of a weapon as high or tomatic pistols contain a magazine of cartridges which

Bullet 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


mporaty Cevtty

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

typically holds 9 to 19 rounds and can be fired by re- officials in situations where innocent bystanders near
peatedly pulling the trigger. Handguns are favored in the target victim may be endangered by passing of the
urban warfare because they are easily concealed and are bullet through the intended target. Little is known about
effective at short ranges; most shootings occur within the risk of in-vivo retention of undetonated exploding
7 yards of the target person (20). bullets; however, extreme care must be taken during
Shotguns, depending on the range from the target and their removal because simple manipulation can cause
the size of the pellets fired, may cause minor to massive them to detonate (22).
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- Concluding remarks
powder by plastic or cardboard wadding. This wadding
can frequently be found in wounds inflicted at short The primary factors in tissue wounding include the
range. Shotguns are classified by ‘gauge’, which indi- amount of kinetic energy delivered to the subject and
cates the weight of the pellets fired by the weapon in tissue-bullet interaction. Sonic waves produced by pro-
fractions of a pound. For example, a 12-gauge shotgun jectile impact do not significantly affect most organ sys-
shoots pellets that weigh 1/12th of a pound each. The tems. The size of the permanent cavity produced, which
barrel of a shotgun is smooth and is constricted by a is the most significant component of tissue damage, de-
‘choke’ on the muzzle which narrows the exit diameter pends on bullet energy, tumbling, expansion, and frag-
and therefore helps decrease the spread of the pellets in mentation within the target. The temporary cavity pro-
flight. ‘Sawing off’ the end of the shotgun serves both duced by bullet impact can be large, but for most elas-
to increase the spread of the shotgun pellets for use in tic tissues causes only minor damage.
close-range combat and to make the weapon easier to Of the three basic firearms, rifles have the greatest
conceal (21). wounding capacity at long distances. Shotguns are ca-
pable of producing massive wounds at close ranges.
Handguns, particularly with the advent of deforming
Bullet design and fragmenting bullets, can also induce massive
wounding and can be easily concealed.
As noted above, bullet interaction with tissue plays a Future research in ballistics will include the mathe-
major role in determining the wounding capacity of any matical and statistical modelling of bullet flight and tis-
given firearm. Military bullet design is governed by the sue damage, the characterization of the true injury
Hague Convention of 1899 which mandated that these caused by the temporary cavity and sonic waves, the
bullets be surrounded by a full metal jacket (1). This jack- further study of alternative projectile systems (such as
eting consists of a hard metallic outer coating, such as fragmentation devices), the definition of the biological
copper, which surrounds the softer inner bullet which response to projectile wounding, and the continued
consists of lead. This allows for higher weapon veloci- evaluation of the newest available firearms in modern
ties, since unjacketed lead cannot be fired faster than day civilian and military warfare (17,24,25).
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- References
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Injury 1997, Vol. 28, Suppl. 3