Current Reviews in Musculoskeletal Medicine

, Volume 8, Issue 3, pp 312–317 | Cite as

High velocity gunshot injuries to the extremities: management on and off the battlefield

  • Jowan G. Penn-BarwellEmail author
  • Kate V. Brown
  • C. Anton Fries
Gunshot Wounds and Blast Injuries (D Stinner and MK Sethi, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Gunshot Wounds and Blast Injuries


The gunshot wounds sustained on the battlefield caused by military ammunition can be different in nature to those usually encountered in the civilian setting. The main difference is that military ammunition has typically higher velocity with therefore greater kinetic energy and consequently potential to destroy tissue. The surgical priorities in the management of gunshot wounds are hemorrhage control, preventing infection, and reconstruction. The extent to which a gunshot wound needs to be surgically explored can be difficult to determine and depends on the likely amount of tissue destruction and the delay between wounding and initial surgical treatment. Factors associated with greater energy transfer, e.g., bullet fragmentation and bony fractures, are predictors of increased wound severity and therefore a requirement for more surgical exploration and likely debridement. Gunshot wounds should never be closed primarily; the full range of reconstruction from secondary intention to free tissue transfer may be required.


Ballistic Combat War Gunshot wounds Injuries Gun 



No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. The authors are all serving medical officers in the UK Armed Forces.

Compliance with Ethics Guidelines

Conflict of Interest

None of the authors have any conflicts of interest with the subject of this work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Crown Copyright 2015

Authors and Affiliations

  • Jowan G. Penn-Barwell
    • 1
    Email author
  • Kate V. Brown
    • 1
  • C. Anton Fries
    • 1
  1. 1.Academic Department of Military Surgery and TraumaRoyal Centre for Defence Medicine (RCDM)BirminghamUK

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