- Email: [email protected]
A curious gunshot injury
Injury, 9, 327-328
327
Printedin Great Britain
A curious gunshot injury Raymond A. B. Mollan Royal Victoria Hospital, Belfast
Victor Beavis Northern Ireland Forensic Laboratory, Belfast Summary The case of a victim of an unusual gunshot injury is described. The man had been 'knee-capped' and on arrival at hospital was found to have two bullets and a cartridge casing in the knee joint. These had entered through one entrance wound. A ballistic report describes how the incident occurred. ONE result of the urban guerilla war in N o r t h e r n Ireland is the admission to hospital of patients who have been the victims of the various paramilitary organizations' 'kangaroo courts'. Punishments meted out vary from tarring and feathering to murder; an intermediate punishment is to shoot the victim in the back of the leg--so-called 'knee-capping'. I n 1976 the total number o f shootings investigated by the N o r t h e r n Ireland Forensic L a b o r a t o r y was 1883, of which 196 were murders and 98 were cases of knee-capping. The treatment of these injuries is now standard and an excellent study of knee-cappings was carried out by N i x o n (1975). Despite the n a m e 'knee-capping', very few bullets are recovered f r o m the knee j o i n t ; the main danger in this lesion is the vascular injury. However, bullets in the knee joint itself, and even those projecting into it, must be removed, for, apart f r o m the mechanical reasons, any lead object bathed in synovial fluid is slowly dissolved, and this sets up an intense synovitis (Wilson, 1976).
CASE REPORT An 18-year-old male was knee-capped on the left side. He remembers only one pistol shot. Some minutes later he was found to have an entrance wound on the posterolateral aspect of his left leg at the level of the knee joint. There was no nerve or vascular injury.
Fig. 1. Lateral radiograph clearly showing two spent bullets and a spent cartridge case. X-ray examination showed the presence of two bullets and one cartridge case in the intercondylar area of the left femur (Fig. 1). Surgical exploration was carried out by excising the wound and laying open the popliteal fossa. The knee joint was then opened by an oblique anterolateral incision and the metal fragments were recovered from the intercondylar area, one being embedded in bone. Damage to the ligaments and articular cartilage was minimal. The joint was closed at once and the posterior wound was closed by delayed primary suture 5 days later. The patient made an uneventful recovery and was discharged from hospital after 17 days. Knee function was full at 8 weeks after operation.
BALLISTIC REPORT In this very unusual incident two spent bullets of different calibres and a spent cartridge case were recovered. The bullets were of .32 calibre and 9380 calibre (Fig. 2a). The cartridge case was .32
328
Injury : the British Journal of Accident Surgery Vol. 9/No. 4
a
b
Fig. 2. a, The two spent bullets: the upper one "380,
the lower one "32 calibre ( x 2.) b, The spent cartridge case. ( x 2.) calibre (Fig. 2b). It is unusual to recover two bullets of different calibre f r o m a single gunshot wound, but the finding of a cartridge case was most interesting. The sequence o f events was as follows. A .32 round had been inadvertently loaded into the chamber o f a .380 semiautomatic pistol. The attempt to discharge this r o u n d resulted in a misfire. The smaller round lodged part way d o w n the barrel and so prevented the firing pin f r o m striking the primer of the cartridge. A fresh .380 round was then loaded into the chamber and this time, on pulling the trigger, the .380 round discharged, striking the primer of the lodged .32
Fig. 3. The missiles in sequence from left to right: the spent "380 bullet, the '32 cartridge and .32 bullet in firing sequence.
r o u n d and causing it to discharge. Thus three projectiles were driven down the barrel; a .32 bullet, its .32 cartridge case and a -380 bullet (Fig. 3).
Acknowledgement W e would like to thank M r R. I. Wilson for allowing us to report this unique case, which was under his care. REFERENCES Nixon J. (1975) 'Knee-capping'. Dissertation for MCh(Orth) Thesis. Wilson R. I. (1976) Personal communication.
Requests for reprints should be addressed to: Mr R. A. B. Mollan, Royal VictoriaHospital, Belfast,Northern Ireland.
327
Printedin Great Britain
A curious gunshot injury Raymond A. B. Mollan Royal Victoria Hospital, Belfast
Victor Beavis Northern Ireland Forensic Laboratory, Belfast Summary The case of a victim of an unusual gunshot injury is described. The man had been 'knee-capped' and on arrival at hospital was found to have two bullets and a cartridge casing in the knee joint. These had entered through one entrance wound. A ballistic report describes how the incident occurred. ONE result of the urban guerilla war in N o r t h e r n Ireland is the admission to hospital of patients who have been the victims of the various paramilitary organizations' 'kangaroo courts'. Punishments meted out vary from tarring and feathering to murder; an intermediate punishment is to shoot the victim in the back of the leg--so-called 'knee-capping'. I n 1976 the total number o f shootings investigated by the N o r t h e r n Ireland Forensic L a b o r a t o r y was 1883, of which 196 were murders and 98 were cases of knee-capping. The treatment of these injuries is now standard and an excellent study of knee-cappings was carried out by N i x o n (1975). Despite the n a m e 'knee-capping', very few bullets are recovered f r o m the knee j o i n t ; the main danger in this lesion is the vascular injury. However, bullets in the knee joint itself, and even those projecting into it, must be removed, for, apart f r o m the mechanical reasons, any lead object bathed in synovial fluid is slowly dissolved, and this sets up an intense synovitis (Wilson, 1976).
CASE REPORT An 18-year-old male was knee-capped on the left side. He remembers only one pistol shot. Some minutes later he was found to have an entrance wound on the posterolateral aspect of his left leg at the level of the knee joint. There was no nerve or vascular injury.
Fig. 1. Lateral radiograph clearly showing two spent bullets and a spent cartridge case. X-ray examination showed the presence of two bullets and one cartridge case in the intercondylar area of the left femur (Fig. 1). Surgical exploration was carried out by excising the wound and laying open the popliteal fossa. The knee joint was then opened by an oblique anterolateral incision and the metal fragments were recovered from the intercondylar area, one being embedded in bone. Damage to the ligaments and articular cartilage was minimal. The joint was closed at once and the posterior wound was closed by delayed primary suture 5 days later. The patient made an uneventful recovery and was discharged from hospital after 17 days. Knee function was full at 8 weeks after operation.
BALLISTIC REPORT In this very unusual incident two spent bullets of different calibres and a spent cartridge case were recovered. The bullets were of .32 calibre and 9380 calibre (Fig. 2a). The cartridge case was .32
328
Injury : the British Journal of Accident Surgery Vol. 9/No. 4
a
b
Fig. 2. a, The two spent bullets: the upper one "380,
the lower one "32 calibre ( x 2.) b, The spent cartridge case. ( x 2.) calibre (Fig. 2b). It is unusual to recover two bullets of different calibre f r o m a single gunshot wound, but the finding of a cartridge case was most interesting. The sequence o f events was as follows. A .32 round had been inadvertently loaded into the chamber o f a .380 semiautomatic pistol. The attempt to discharge this r o u n d resulted in a misfire. The smaller round lodged part way d o w n the barrel and so prevented the firing pin f r o m striking the primer of the cartridge. A fresh .380 round was then loaded into the chamber and this time, on pulling the trigger, the .380 round discharged, striking the primer of the lodged .32
Fig. 3. The missiles in sequence from left to right: the spent "380 bullet, the '32 cartridge and .32 bullet in firing sequence.
r o u n d and causing it to discharge. Thus three projectiles were driven down the barrel; a .32 bullet, its .32 cartridge case and a -380 bullet (Fig. 3).
Acknowledgement W e would like to thank M r R. I. Wilson for allowing us to report this unique case, which was under his care. REFERENCES Nixon J. (1975) 'Knee-capping'. Dissertation for MCh(Orth) Thesis. Wilson R. I. (1976) Personal communication.
Requests for reprints should be addressed to: Mr R. A. B. Mollan, Royal VictoriaHospital, Belfast,Northern Ireland.