• David C Kieser, Debra J Carr, Sandra C J Leclair, Ian Horsfall, Jean-Claude Theis, Mike V Swain, and Jules A Kieser.
• Orthopaedic Surgery, Surgical Sciences, Health Sciences, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand. kieserdavid@gmail.com
• J Orthop Surg Res. 2013 Jan 1;8:15.

BackgroundRemote ballistic femoral fractures are rare fractures reported in the literature but still debated as to their existence and, indeed, their treatment. This study aimed to prove their existence, understand how they occur and determine which ammunition provides the greatest threat. In addition, fracture patterns, soft tissue disruption and contamination were assessed to aid in treatment planning.MethodWe filmed 42 deer femora embedded in ballistic gelatine and shot with four different military (5.56 × 45 mm, 7.62 × 39 mm) and civilian (9 × 19 mm, .44 in.) bullets, at varying distances off the bone (0-10 cm).ResultsTwo remote ballistic fractures occurred, both with .44 in. hollow-point bullets shot 3 cm off the bone. These fractures occurred when the leading edge of the expanding temporary cavity impacted the femur's supracondylar region, producing a wedge-shaped fracture with an undisplaced limb, deceivingly giving the appearance of a spiral fracture. No communication was seen between the fracture and permanent cavity, despite the temporary cavity encasing the fracture and stripping periosteum from its base.ConclusionThese fractures occur with civilian ammunition, but cannot prove their existence with military rounds. They result from the expanding temporary cavity affecting the weakest part of the bone, creating a potentially contaminated wedge-shaped fracture, important for surgeons considering operative intervention.

21 keywords...

hide…