Skip to main content
SpringerLink
Log in

Penetrating gunshots to the head and lack of immediate incapacitation

I. Wound ballistics and mechanisms of incapacitation

  • Review Article
  • Published:
International Journal of Legal Medicine Aims and scope Submit manuscript

Abstract

There are two distinct mechanisms of ballistic injury. Crushing of tissue resulting in a permanent tract is the primary factor in wounding of most tissues and most body regions. Temporary cavitation causes radial tissue displacement and subsequent shearing, compression and especially stretching of tissue analogous to blunt trauma. In contrast to the effect in elastic tissue, temporary cavitation can contribute substantially to wounding of inelastic tissue, such as the brain. This is the case in penetrating gunshot wounds to the head. Additionally, the penetration of the bony cranium can produce secondary missiles in the form of bone or bullet fragments and a tendency of the bullet to deformation and early yaw. Most important, wounding resulting from temporary cavitation is greatly augmented by the confined space provided by the unyielding walls of the skull. Bone contact and enhanced effects of temporary cavitation result in an enlarged zone of disintegrated tissue and in high intracranial peak pressures. Morphological signs of powerful intracranial pressure effects are cortical contusion zones, indirect skull fractures and perivascular haemorrhages remote from the tract. Depending on ballistic and anatomical parameters, the intracranial effect varies from slightly more severe injury than in isolated soft tissue to an “explosive” type of injury with comminuted fractures of the skull and laceration of the brain. Incapacitation is the physiologically based inability to perform complex and longer lasting movements independent of consciousness or intention. Immediate incapacitation is possible following craniocerebral gunshot wounds or wounds that disrupt the upper cervical spinal cord only. Rapid incapacitation can be produced by massive bleeding from major vessels or the heart. Immediate incapacitation is the result of primary intracranial effects of the bullet. A mechanism similar to commotio cerebri applied extracranially does not exist in cases of penetrating gunshot wounds to the head.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Allen IV, Scott R, Tanner JA (1982) Experimental high-velocity missile head injury. Injury 14:183–193

    PubMed  Google Scholar 

  • Allen IV, Kirk J, Maynard RL, Cooper GK, Scott R, Crockard A (1983) Experimental penetrating head injury: some aspects of light microscopical and ultrastructural abnormalities. Acta Neurochir Suppl (Wien) 32:99–104

    Google Scholar 

  • Barnett JC, Meirowsky AM (1955) Intracranial hematomas associated with penetrating wound of the brain. J Neurosurg 12:34–38

    PubMed  Google Scholar 

  • Berg S (1964) Die Durchschlagskraft von Pistolengeschossen im menschlichen Körper. Arch Kriminol 134:17–23

    Google Scholar 

  • Beyer JC (ed) (1962) Wound ballistics. Office of the Surgeon General, Department of the Army, Washington DC, p 135

    Google Scholar 

  • Black AN, Burns BD, Zuckerman S (1941) An experimental study of the wounding mechanism of high-velocity missiles. BMJ 2:872–874

    Google Scholar 

  • Bowen TE, Bellamy RF (1988) Emergency war surgery, second United States revision of the emergency war surgery handbook. United States Department Of Defense, Washington DC, pp 1333

    Google Scholar 

  • Butler FG, Puckett WO, Harvey EN, McMillan JH (1945) Experiments on head wounding by high velocity missiles. J Neurosurg 2:358–363

    Google Scholar 

  • Callender GR, French RW (1935) Wound ballistics. Studies in the mechanism of wound production by rifle bullets. Mil Surg 77:177–201

    Google Scholar 

  • Carey ME, Sarna GS, Farrel JB, Happel LT (1989) Experimental missile wound to the brain. J Neurosurg 71:754–764

    PubMed  Google Scholar 

  • Clemedson CJ, Falconer B, Frankenberg L, Jönsson A, Wennerstrand J (1973) Head injuries caused by small-calibre, high-velocity bullets. Z Rechtsmed 73:103–114

    PubMed  Google Scholar 

  • Cooper GJ, Ryan JM (1990) Interaction of penetrating missiles with tissues: some common misapprehensions and implications for wound management. Br J Surg 77:606–610

    PubMed  Google Scholar 

  • Crockard HA (1975) Early intracranial pressure studies in gunshot wounds of the brain. J Trauma 15:339–347

    PubMed  Google Scholar 

  • Crockard HA, Brown FD, Johns LM, Mullan S (1977a) An experimental cerebral missile injury model in primates. J Neurosurg 46:776–783

    PubMed  Google Scholar 

  • Crockard HA, Brown FD, Calica AB, Johns LM, Mullan S (1977b) Physiological consequences of experimental cerebral missile injury and use of data analysis to predict survival. J Neurosurg 46:784–794

    PubMed  Google Scholar 

  • Denny-Brown D, Russel WR (1941) Experimental cerebral concussion. Brain 64:93–164

    Google Scholar 

  • DiMaio VJM (1985) Gunshot wounds. Practical aspects of firearms, ballistics and forensic techniques. Elsevier, New York Amsterdam Oxford

    Google Scholar 

  • DiMaio VJM, Zumwalt RE (1977) Rifle wounds from high velocity, center-fire hunting ammunition. J Forensic Sci 22:132–140

    PubMed  Google Scholar 

  • DiMaio VJM, Jones JA, Caruth WW III, Anderson LL, Petty CS (1974) A comparison of the wounding effects of commercially available handgun ammunition suitable for police use. FBI Law Enforce Bull 43 (12):3–8

    Google Scholar 

  • Dittmann W (1989) Wundballistische Untersuchungen zur Klinik der Schädel-Hirn-Schußverletzungen. Wehrmed Monatsschr 33:3–14

    Google Scholar 

  • Dzieman AJ, Mendelson JA, Lindsey D (1961) Comparison of the wounding characteristics of some commonly encountered bullets. J Trauma 1:341–353

    PubMed  Google Scholar 

  • Fackler ML (1987) Position paper. In: Wound ballistic workshop, Quantico, September 15–17, 1987: 9 mm vs .45 auto, FBI Academy Firearms Training Unit, pp 8–17

  • Fackler ML (1988) Wound ballistics. A review of common misconceptions. JAMA 259:2730–2736

    PubMed  Google Scholar 

  • Fackler ML (1989) Wounding patterns of military rifle bullets. Int Defense Rev 1:59–64

    Google Scholar 

  • Fackler ML (1991) Comment to Cat Brain Shots. Wound Ballistics Rev 1(1):41–42

    Google Scholar 

  • Fackler ML (1992) Police handgun ammunition selection. Wound Ballistics Rev 1(3):32–37

    Google Scholar 

  • Fackler ML, Malinowski JA (1985) The wound profile: a visual method for quantifying gunshot wound components. J Trauma 25:522–529

    PubMed  Google Scholar 

  • Fackler ML, Peters CE (1991) The “shock wave” myth (and comment). Wound Ballistics Rev 1(1):38–40

    Google Scholar 

  • Fackler ML, Surinchak JS, Malinowski JA, Brwen RE (1984a) Bullet fragmentation: a major cause of tissue disruption. J Trauma 24:35–39

    PubMed  Google Scholar 

  • Fackler ML, Surinchak JS, Malinowski JA, Bowen RE (1984b) Wounding potential of the Russian AK-74 assault rifle. J Trauma 24:263–266

    PubMed  Google Scholar 

  • Fackler ML, Bellamy RF, Malinowski JA (1988) The wound profile: Illustration of the missile-tissue interaction. J Trauma 28(1)[Suppl]:S21-S29

    PubMed  Google Scholar 

  • Finnie JW (1993) Pathology of experimental traumatic craniocerebral missile injury. J Comp Pathol 108:93–101

    PubMed  Google Scholar 

  • Freytag E (1963) Autopsy findings in head injuries from firearms. Statistical evaluation of 254 cases. Arch Pathol (Lond) 76:215–225

    Google Scholar 

  • Gerber AM, Moody RA (1972) Craniocerebral missile injuries in the monkey: an experimental physiological model. J Neurosurg 36:43–49

    PubMed  Google Scholar 

  • Goroncy C (1924) Handlungsfähigkeit Kopfschußverletzter. Dtsch Z Gerichtl Med 4:145–164

    Google Scholar 

  • Harvey EN, Butler EG, McMillan JH, Puckett WO (1945) Mechanism of wounding. War Med 8:91–104

    Google Scholar 

  • Harvey EN, Korr IM, Oster G, McMillan JH (1947) Secondary damage in wounding due to pressure changes accompanying the passage of high velocity missiles. Surgery 21:218–239

    Google Scholar 

  • Hatcher JS (1935) Textbook of pistols and revolvers. Their ammunition, ballistics and use. Smallarms technical publications company, Marines

  • Henn R, Liebhardt E (1969) Zur Topik außerhalb des Schußkanals gelegener Hirnrindenblutungen. Arch Kriminol 143:188–191

    Google Scholar 

  • Hollerman JJ, Fackler ML, Coldwell DM, Ben-Menachem Y (1990) Gunshot wounds. 1. Bullets, ballistics and mechanisms of injury. AIR 155:685–690

    Google Scholar 

  • Hopkinson DAW, Watts JC (1963) Studies in experimental missile injuries of skeletal muscle. Proc R Soc Med 56:461–468

    PubMed  Google Scholar 

  • Illchmann-Christ A (1951) Zur Frage der Beurteilung der Handlungsfähigkeit und Lebensdauer nach stumpfen Schädeltraumen. Arch Orthop Unfallchir 44:586–605

    PubMed  Google Scholar 

  • Jason A (1991) The “twilight zone” of wound ballistics. Wound Ballistics Rev 1(1):8–9

    Google Scholar 

  • Kaufman HH, Loyola WP, Makela ME, Frankowsky RF, Wagner KA, Bustein DP, Gildenberg PC (1986) Gunshot wounds to the head: a perspective. Neurosurgery 18:689–695

    PubMed  Google Scholar 

  • Kirkpatrick JB, DiMaio VJM (1978) Civilian gunshot wounds of the brain. J Neurosurg 48:185–198

    Google Scholar 

  • Klages U, Weithoener D, Frössler H, Terwort H (1975) Überlebenszeit, Handlungsfähigkeit und röntgenologische Diagnostik bei Schußverletzungen des Schädels. Z Rechtsmed 76:307–319

    PubMed  Google Scholar 

  • Klaue R (1949) Die indirekten Frakturen der vorderen Schädelgrube beim Schädeldachschuß. Dtsch Z Nervenheilkd 161:167–193

    Google Scholar 

  • Knudsen PJT, Theilade P (1993) Terminal ballistics of the 7.62 mm NATO bullet. Autopsy findings. Int J Legal Med 106:61–67

    PubMed  Google Scholar 

  • Kocher T (1895) Zur Lehre von den Schußwunden durch die Kleinkalibergeschosse. Fischer, Cassel

    Google Scholar 

  • Kolsky H (1980) The role of stress waves in penetration processes. In: Labile RC (ed) Ballistic materials and penetration mechanics. Elsevier, New York, pp 185–223

    Google Scholar 

  • König HG, Schmidt V (1989) Beobachtungen zur Ausbreitungsgeschwindigkeit und Entstehungsursache von Berstungsfrakturen beim Schuß. Beitr Gerichtl Med 47:247–255

    PubMed  Google Scholar 

  • Krauss M (1957) Studies in wound ballistics: temporary cavity effects in soft tissues. Mil Med 121:221–231

    PubMed  Google Scholar 

  • Krönlein RU (1899) Beitrag zur Lehre der Schädel-Hirnschüsse aus unmittelbarer Nähe mittels des schweizerischen Repetiergewehrs Modell 1889. Arch Klin Chir 59:67–76

    Google Scholar 

  • Lampel W, Langenbach HJ (1961) Geschoßwirkung auf Wild. Wild Hund 64:41–52

    Google Scholar 

  • Levy V, Rao VJ (1988) Survival time in gunshot and stab wound victims. Am J Forensic Med Pathol 9:215–217

    PubMed  Google Scholar 

  • Lindsey D (1980) The idolatry of velocity, or lies, damn lies, and ballistics. J Trauma 20:1068–1069

    PubMed  Google Scholar 

  • Lorenz R (1948) Der Schußkanal im Röntgenbilde. Dtsch Z Gerichtl Med 39:435–448

    Google Scholar 

  • Meixner K (1931) Die Handlungsfähigkeit Schwerverletzter. Dtsch Z Gerichtl Med 16:139–165

    Google Scholar 

  • Mertens (1917) Ein Beitrag zur Erklärung der Krönlein'schen Schädel-Hirnschüsse. Beitr Klin Chir 108:371–394

    Google Scholar 

  • Metter D, Schulz E (1983) Morphologische Merkmale der Schußwunden in Leber und Milz. Z Rechtsmed 90:167–172

    PubMed  Google Scholar 

  • Naegeli O (1884) Zwei perforirende Hirnschüsse. Mord oder Selbstmord? Vjschr Gerichtl Med 40:231–264

    Google Scholar 

  • Newgard K (1992) The physiological effects of handgun bullets. Wound Ballistics Rev 1(3):12–17

    Google Scholar 

  • Noetzel H (1948) Über die Hirnkontusion beim einfachen äußeren Prellschuß. Nervenarzt 19:12–21

    Google Scholar 

  • Oehmichen M, König HG, Staak M (1985) Morphologie des Hirnschusses. Beitr Gerichtl Med 43:55–61

    PubMed  Google Scholar 

  • Pankratz H, Fischer H (1985) Zur Wundballistik des KrönleinSchusses. Z Rechtsmed 95:213–215

    PubMed  Google Scholar 

  • Payr E (1922) Der frische Schädelschuß. In: Schjerning O von (ed) Handbuch der ärztlichen Erfahrungen im Weltkrieg 1914/1918, vol 1. Barth, Leipzig, pp 285–410

    Google Scholar 

  • Peng L, Cheng Z, Guangji Z, Yinqiou L, Reifeng G (1990) An experimental study of craniocerebral injury caused by 7.62 mm bullets in dogs. J Trauma (China) Suppl 6(2):187–191

    Google Scholar 

  • Petersohn F (1967) Über die Aktions- und Handlungsfähigkeit bei schweren Schädeltraumen. Dtsch Z Gerichtl Med 59:259–270

    Google Scholar 

  • Ragsdale BD, Josselson A (1988) Experimental gunshot fractures. J Trauma Suppl 28(1):S109-S115

    Google Scholar 

  • Robens W, Kusswetter W (1982) Fracture typing to human bone by assault missile trauma. Acta Chir Scand Suppl 508:223–227

    PubMed  Google Scholar 

  • Schorstein J (1947) Intracranial haematoma in missile wounds. Br J Surg War Surg Suppl 1:96–111

    Google Scholar 

  • Schrader G (1942) Selbstmord durch 5 Herzschüsse. Beitr Gerichtl Med 16:117–120

    Google Scholar 

  • Scott R (1983) Pathology of injuries caused by high-velocity missiles. Clin Lab Med 3:273–294

    PubMed  Google Scholar 

  • Sellier K (1971) Über Geschoßablenkung und Geschoßdeformation. Z Rechtsmed 69:217–251

    PubMed  Google Scholar 

  • Sellier K (1982) Schußwaffen und Schußwirkungen I. Schmidt-Römhild, Lübeck, pp 252–254

  • Sellier K, Kneubuehl BP (1994) Wound ballistics and the scientific background. Elsevier, Amsterdam London New York Tokyo, pp 144–149, 245

    Google Scholar 

  • Siccardi D, Cavaliere R, Pau A, Lubinu F, Turtas S, Viale GL (1991) Penetrating craniocerebral missile injuries in civilians: a retrospective analysis of 314 cases. Surg Neurol 35:455–460

    PubMed  Google Scholar 

  • Sight WP (1969) Ballistic analysis of shotgun injuries to the central nervous system. J Neurosurg 31:25–33

    PubMed  Google Scholar 

  • Smith OC (1987) Position paper, incapacitation effectiveness. In: Wound Ballistic Workshop, Quantico, 15–17 September 1987: 9 mm vs .45 auto, FBI Academy Firearms Training Unit, pp 22–25

  • Smith OC, Berryman HE, Lahren CH (1987) Cranial fracture pattems and estimate of direction from low velocity gunshot wounds. J Forensic Sci 32:1416–1421

    PubMed  Google Scholar 

  • Spatz H (1941) Gehirnpathologie im Kriege. Von den Gehirnwunden. Zentralbl Neurochir 6:162–212

    Google Scholar 

  • Spitz WU, Petty CS, Fisher RS (1961) Physical activity until collapse following fatal injury by firearms and sharp pointed weapons. J Forensic Sci 6:290–300

    Google Scholar 

  • Strassmann G (1935) Über Lebensdauer und Handlungsfähigkeit Schwerverletzter. Dtsch Z Gerichtl Med 24:393–400

    Google Scholar 

  • Sturdivan L (1969) Terminal behavior of the 5.56 mm ball in soft targets. Ballistic Research Laboratory, Aberdeen Proving Grounds, Report 1447

  • Suneson A, Hansson H-A, Seeman T (1988) Central and peripheral nervous damage following high-energy missile wounds in the thigh. J Trauma Suppl 28:S197-S203

    Google Scholar 

  • Tamaska L (1968) Die gerichtsmedizinische Bedeutung der sekundären traumatischen Stammhirnblutungen. Beitr Gerichtl Med 24:131–138

    Google Scholar 

  • Unterharnscheidt F (1993) Pathologie des Nervensystems, VI/A. Traumatologie von Him und Rückenmark. Springer, Berlin Heidelberg New York, pp 45–46, 369–371

    Google Scholar 

  • Walcher K (1929) Über Bewußtosigkeit und Handlungsunfähigkeit. Dtsch Z Gerichtl Med 13:313–322

    Google Scholar 

  • Watkins FP, Pearce BP, Stainer MC (1988) Physical effects of the penetration of head simulants by steel spheres. J Trauma Suppl 28(1):S40-S54

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Legal Medicine, Westfälische Wilhelms-Universität, Von-Esmarch-Strasse 86, D-48149, Münster, Germany

    B. Karger

Authors
  1. B. Karger
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Karger, B. Penetrating gunshots to the head and lack of immediate incapacitation. Int J Leg Med 108, 53–61 (1995). https://doi.org/10.1007/BF01369905

Download citation

  • Received:

  • Revised:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01369905

Key words

Search

Navigation