title: Penetrating thoracic wounds caused by plastic bullets.
abstract: Thoracic penetrating injuries caused by a new plastic bullet were studied to determine the nature of the wounds and the appropriate management. Twenty-six casualties from the Israeli-Palestinian conflict (Intifada) were included. The organs most commonly involved were lung (n = 21), bony chest wall (n = 9), heart (n = 3), and diaphragm. Bleeding was at least moderate in 20 patients, amounting in all patients to an average of 975 ml. Thoracotomy was required in 11 patients (42%) mainly because of cardiac injury (n = 3) and aortic or other arterial bleeding (n = 3). Simple oversewing of severed organs (n = 8) or ligation of bleeding vessels (n = 3) was satisfactory. Two patients died (7.7% mortality); one after major liver resection; the other was dead on arrival. We conclude that plastic bullets have a linear course unless displaced by the bony chest wall, when they tend to fragment and cause simple fractures. Fired from a presumed range of at least 70 m, plastic bullets behave like low-velocity missiles, and tissue destruction is minimal. Management should be similar to that of civilian thoracic penetrating trauma.
authors.affiliation: Department of Thoracic, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Yellin
authors.forename: M
authors.initials: M
authors.lastname: Golan
authors.forename: E
authors.initials: E
authors.lastname: Klein
authors.forename: I
authors.initials: I
authors.lastname: Avigad
authors.forename: J
authors.initials: J
authors.lastname: Rosenman
authors.forename: Y
authors.initials: Y
authors.lastname: Lieberman
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D008297:Male; D010969:Plastics; D011859:Radiography; D013898:Thoracic Injuries / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy
chemical_list: D010969:Plastics