Fragmenting Munitions

Abstract

Energised fragments represent a heterogenous range of ballistic projectiles which are produced by an explosive event. Such encounters can occur in both the civilian environment due to terrorism as well as on the battlefield. In current conflicts fragmentation wounds have outnumbered those caused by bullets, with the UK and US experiences in Iraq and Afghanistan finding 74–81% of service personnel being caused by fragments [1, 2]. Bullet wounds tend to be more common in smaller scale conflicts such as the Falklands war or those involving jungle warfare or urban counter insurgency operations [3–5]. Excluding the effects of blast, the lethality of fragmentation weapons is generally far less than bullets, with the exception of artillery shells which produce large fragments at high exit velocities (in the region of 1500–2000 m/s) [6]. Hand grenades in particular are designed to produce a high number of small fragments and often incorporate spheres which are more aerodynamic and thereby increase effective range [7]. The result is to produce many multiply injured survivors that cause a greater burden on healthcare resources and the logistical chain. A large variety of munitions and devices are designed to produce fragments. Such munitions generally either utilise preformed fragments or the explosive force produced within the munition acts to break up the metallic casing (Table 3.1). Personal armour has altered the pattern of distribution of fragmentation injury so that the most common casualty seen on today’s battlefield will have multiple extremity, neck, and facial wounds (Chap. 7) [8]. All war wounds are inherently contaminated by organisms through soil, clothing, and skin, and this is potentiated in buried explosive devices such as mines. Bacteria include Clostridia, Streptococcus, Staphylococcus, Proteus, E. Coli, and Enterococcus, although infection is uncommon in small low-velocity wounds of the extremity. In addition, clinicians need to be aware of the presence of fungal infections (e.g. Aspergillus) following fragmentation injury. This is particularly common in incidents where the device has been buried in farmland. These infections result in significant morbidity, requiring multiple surgical debridements and often lead to sequential revision of amputation stumps [9].