Ballistic Trauma

Description

This presentation led by Jowan Penn-Barwell, an orthopedic trauma surgeon, delves into the complex topic of ballistic trauma, emphasizing the management and assessment of gunshot wounds. It begins with a historical perspective on surgical treatments for such injuries and raises questions about whether recent medical practices have become excessively aggressive. Penn-Barwell explains the need to analyze the pathology of wounds inflicted by high kinetic energy projectiles, highlighting that the degree of kinetic energy transfer is a key determinant of the severity and complexity of the resulting injuries.



The discussion moves on to identifying types of injuries based on the mechanism of action of different firearms, distinguishing between lower energy and higher energy firearms while stressing that surgeons treat injuries, not weapon systems. The presentation references significant studies demonstrating the association between bone tissue injury and kinetic energy transfer as a critical guide for treatment decisions.



Penn-Barwell critiques the current aggressive surgical guidelines outlined by the International Committee of the Red Cross, advocating for a more measured approach that considers the energy transfer rather than just the weapon involved. He reviews the consequences of ballistic injuries on different biological tissues, elucidating how tissue types respond variably to such injuries, which is crucial for determining treatment protocols.



Throughout the talk, attendees are encouraged to think critically about injury assessment, classification, and management strategies, highlighting the potential risks of excessive surgical interventions. Moreover, Penn-Barwell underscores the importance of conservative management in low-energy ballistic injuries and outlines strategies for stabilization and treatment of complex wounds. He concludes with advice on maintaining a balance between aggressive debridement and prudent observation to optimize patient outcomes.

DOI: 10.1302/3114-230052

Specialties