Stratification of risk to the surgical team in removal of small arms ammunition implanted in the craniofacial region: case report

Journal of Neurosurgery
Jonathan A ForbesTravis Newberry

Abstract

In cases of penetrating injury with implantation of small arms ammunition, it can often be difficult to tell the difference between simple ballistics and ballistics associated with unexploded ordnances (UXOs). In the operative environment, where highly flammable substances are often close to the surgical site, detonation of UXOs could have catastrophic consequences for both the patient and surgical team. There is a paucity of information in the literature regarding how to evaluate whether an implanted munition contains explosive material. This report describes a patient who presented during Operation Enduring Freedom with an implanted munition suspicious for a UXO and the subsequent workup organized by Explosive Ordnance Disposal (EOD) Company prior to surgical removal. Clinical risk factors for UXOs include assassination attempts and/or wartime settings. Specific radiological features suggestive of a UXO include projectile size greater than 7.62-mm caliber, alterations in density of the tip, as well as radiological evidence of a hollowed-out core. If an implanted UXO is suspected, risks to the surgical and anesthesia teams can be minimized by notifying the nearest military installation with EOD capabilities and following clini...Continue Reading

References

Mar 13, 1982·British Medical Journal·B Knight
Aug 1, 1996·Annals of Emergency Medicine·D SchlagerR McFall
Dec 25, 2003·Journal of Clinical Pathology·B Swift, G N Rutty
Apr 3, 2008·Neurosurgery·Rahul JandialLarry Sturdivan

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