Penetrating trauma
| Penetrating/Puncture Trauma | |
|---|---|
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| Acute penetrating trauma from a close-range shotgun blast injury to knee. Birdshot pellets are visible in the wound, within the shattered patella. The powder wad from the shotgun shell has been extracted from the wound, and is visible at the upper right of the image. | |
| Classification and external resources | |
| ICD-10 | T14.1 |
Penetrating trauma is an injury that occurs when an object pierces the skin and enters a tissue of the body, creating an open wound. In blunt, or non-penetrating trauma, there may be an impact, but the skin is not necessarily broken. The penetrating object may remain in the tissues, come back out the way it entered, or pass through the tissues and exit from another area. An injury in which an object enters the body or a structure and passes all the way through is called a perforating injury, while penetrating trauma implies that the object does not pass through. Perforating trauma is associated with an entrance wound and an often larger exit wound.
Penetrating trauma can be caused by a foreign object or by fragments of a broken bone. Usually occurring in violent crime or armed combat, penetrating injuries are commonly caused by gunshots and stabbings.
Penetrating trauma can be serious because it can damage internal organs and presents a risk of shock and infection. The severity of the injury varies widely depending on the body parts involved, the characteristics of the penetrating object, and the amount of energy transmitted to the tissues. Assessment may involve X-rays or CT scans, and treatment may involve surgery, for example to repair damaged structures or to remove foreign objects.
Puncture and penetration are similar however a puncture is different from a penetration wound in that there is no exit wound in cases of puncture. This type of trauma can be seen for example in a stabbing, or a gunshot wound in which a low velocity pistol bullet was used.
As a missile passes through tissue, it decelerates, dissipating and transferring kinetic energy to the tissues; this is what causes the injury. The velocity of the projectile is a more important factor than its mass in determining how much damage is done; kinetic energy increases with the square of the velocity. In addition to injury caused directly by the object that enters the body, penetrating injuries may be associated with secondary injuries, due for example to a blast injury. High-velocity objects are usually projectiles such as bullets from high-powered rifles, such as assault rifles or sniper rifles. Bullets classed as medium-velocity projectiles include those from handguns, shotguns, and submachine guns. Low-velocity items, such as knives and swords, are usually propelled by a person's hand, and usually do damage only to the area that is directly contacted by the object. The space left by tissue that is destroyed by the penetrating object as it passes through forms a cavity; this is called permanent cavitation. In addition to causing damage to the tissues they contact, medium- and high-velocity projectiles cause a secondary cavitation injury: as the object enters the body, it creates a pressure wave which forces tissue out of the way, creating a "temporary cavity" that can be much larger than the object itself. The tissues soon move back into place, eliminating the cavity, but the cavitation frequently does considerable damage first. Temporary cavitation can be especially damaging when it affects delicate tissues such as the brain, as occurs in penetrating head trauma.
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