The Down Range Forum
Member Section => Tactical Rifle & Carbine => Topic started by: billt on July 24, 2009, 05:41:56 PM
-
http://www.timawa.net/forum/index.php?topic=17111.0
-
That left a mark :o
I didn't think the exit wound of a 223 would be that traumatic.
-
That left a mark :o
I didn't think the exit wound of a 223 would be that traumatic.
Hey Knight, haven't seen you around much. Everything OK?
As for the exit wound, the posts were interesting (not only because of the blend of English and Phillipino) - the bullet did not hit the bone, but was light and tumbled rather significantly - as the lighter SS109 bullets do. If it were the steel core the exit may not have been so messy, but then I have no clue, no experience, so I am guessing! ;D
-
That left a mark :o
I didn't think the exit wound of a 223 would be that traumatic.
With the appropriate round it did what it is designed to do, come apart at high velocity causing massive wound channel.
-
A drunk cop with an m-16? Now THAT'S a bad day. :D
-
No way that is/was a M-16 entry and exit wound!!! Sorry guys, not biting on this one. ;)
-
You want fries with all that hamburger? ;)
-
Thats why I could never work in an ER (or a war zone).
-
This looks alot like what happened to my friend. Except his was in the Calf the doctor actually made the entry and exits wounds larger to allow for drainage. It was pretty wicked.
This though is crazy cause it is so close to the femoral artery. The fastest way to bleed out is to sever that. When I went through Combat Lifesaver course that was one of the things I took away from it. You can bleed out in 15sec if that it is severed. Alot of motocross riders have died on the track cause of internal bleeding caused by severing the Femoral Artery after breaking their femur.
-
A number of deer hunters have stabbed themselves in the groin while skinning deer and severed that artery. They fell down and died without taking a step. Just one more thing to watch out for. There are more ways to die than you can count.
-
A number of deer hunters have stabbed themselves in the groin while skinning deer and severed that artery. They fell down and died without taking a step. Just one more thing to watch out for. There are more ways to die than you can count.
Yep, I read in some shooting mag about a surgeon who did just that and was found still kneeling in front of the deer with his head on the deer. Even he couldn't save himself. You think direct pressure, pinching the artery, SOMETHING... But, no.
-
No way that is/was a M-16 entry and exit wound!!! Sorry guys, not biting on this one. ;)
It looks completely legit to me both radiographically and pictorially. The exit wound is large due to the bullet hitting the bone and fragmenting (the bullet did not miss the bone and the very strong distal femur does not generally shatter from shockwaves. Hydrolic shock from high velocity rifle rounds can break bone, typically ribs or other small bones but I don't believe that was the case here). The bullet fragments on the AP & Lateral X-rays are consistent with the bullet track shown in the photos and they appear to have struck and exited the distal femur along that track. There is no problem with the femoral artery. It is more proximal and medial (sorry..higher up and more towards the groin) and it bifurcates (splits) into much smaller vessels before the level of the wound.
A lot of manipulation, a distal plate and a dozen or more screws will fix this guy up. The tiny bullet fragments will be left in place. The wound will be thoroughly washed out (with a neat little high pressure water pistol called a Neptune. The saline solution used for the wash out will contain antibiotics), pulses in the lower leg and foot will be checked, vascular repair will be done if needed (unlikely), the soft tissue, muscle and any severed ligaments or tendons will be sewn up, a drain left in place and the wound closed. He'll be pumped full of antibiotics and he should recover fully. He will have some nasty scars, but with a good orthopedic surgeon he won't have even a slight limp. 100% back to normal. While this looks nasty, many automobile accidents leave the femur in much worse shape. Despite appearances, neither the fractures or the wound are all that bad.
Muscle damage could cause problems. A report says that dead muscle was excised. This should not have occured and would be the result of delayed treatment. In the US, this guy would have been in the OR within 30 to 45 minutes tops from his arrival in the Emergency Department. If available, he would have been initially transported to a Level 1 Trauma Center. He would likely have had an IV inserted, been typed and crossed, the preliminary X-rays would be done and possibly followed by a quick CT. Permits signed and off to the OR.
-
...It is more proximal and medial (sorry..higher up and more towards the groin) and it bifurcates (splits) into much smaller vessels before the level of the wound....
Well now you're just showing off. ;D
It's nice to hear from people that know what they are talking about in these sort of things. Nicely explained Kid.
Can say for sure that I wouldn't like to be shot by any kind of projectile stronger then a paintball. Even those I don't care to be shot by. Nasty business, gunshot wounds.
-
Well now you're just showing off. ;D
It's nice to hear from people that know what they are talking about in these sort of things. Nicely explained Kid.
Can say for sure that I wouldn't like to be shot by any kind of projectile stronger then a paintball. Even those I don't care to be shot by. Nasty business, gunshot wounds.
You said it True. I'll even pass on the paintball from close range.
Just curious, what do you think of the "under powered" AR15 in that wimpy .223?
-
You said it True. I'll even pass on the paintball from close range.
Just curious, what do you think of the "under powered" AR15 in that wimpy .223?
I love AR's. So much versatility with them. They are the 10/22 of the center fired world. Every gun person should own at least one.
As far as the wimpy .223, I have never considered it as such. It may be a little light on bullet weight but it does exactly what it was designed to do, impact with high velocity and 'blow up'. As those pictures show, it is pretty damn good at doing just that. It's an accurate round too. Can't ask much more then that especially with the lower overall weight factored in to it.
-
I really don't see how anyone can doubt this was done by a .223. Look at the way that cartridge literally EXPLODES varmints. Yes, I understand they don't varmint hunt with FMJ bullets, but the Mil-Spec 5.56 load is designed to fragment and tumble upon entry. All of that energy has to go somewhere and do something. No doubt in my mind this is a legit .223 wound. Bill T.
-
Dang! I think I need some mouthwash after that. :-X
-
I scrolled down and read some replies,...
Like one said,..
If this had been in the upper chest area,,,,there would be no E.R. necessary.
-
Kid, thanks for the explanation of the treatment. If travel wasn't in my future (assuming I actually find a job) I would sign up for the EMT-B class this fall - step 1 in the treatment path.
As for the bone being hit or not - I was going off the comments on the forum from the guy who gave all of the info on the shooting. I will admit that in the back of my mind, as I looked at the X-rays, that it was pretty serious damage for a shock wave. But I gave the guy the benefit of the doubt. And from some of the slo-mo videos of shots in ballistic gel, there is a heck of a shock wave with those things.
-
ops
I am guessing a Band-Aid did not fix that
from my understanding there was Alcohol involved so.... I am sorry no sympathy from me
-
"Hold my beer and watch this."
-
I hate when that happens.
Very nice explanation Kid......thanks.
-
Great report Kid and scarily, I understood every word you wrote!
Twenty or more, (lost count) surgeries on my hip, face, abdomen and back over the last three years and you tend to learn a bit about human anatomy and the medical terms associated with trauma.
I've shot enough .223 to respect the fact that it does what it was designed to do. I do hope this guy can get back to normal but I know from experience that the pain has only just begun.
-
Great report Kid and scarily, I understood every word you wrote!
Twenty or more, (lost count) surgeries on my hip, face, abdomen and back over the last three years and you tend to learn a bit about human anatomy and the medical terms associated with trauma.
I've shot enough .223 to respect the fact that it does what it was designed to do. I do hope this guy can get back to normal but I know from experience that the pain has only just begun.
All I will add to that is the standard +1.
-
After seeing that I'm more impressed with the .223, (I'd still stick with trick ammo, I'm not in the service any more so I'm not limited to FMJ.) I wondered about the bandage on the guys foot though.
-
I believe it, I have shot a lot of game with a .223, including my biggest whitetail buck, 250lbs and netted 151" Boone and Crockett. Shot in the neck at 80 yards with a 55grn, barnes X, the bullet did not exit, when cleaning and I was skinning the neck, the meat was nothing but purple jelly in a 10" radius. I do not hunt large game with this cartridge as a rule, but my wife brought her rifle, forgot her ammo, so I loaned her mine, and I took the .223 in hopes of getting a turkey, then this big boy showed up, decisions, decisions ;) The barnes bullets are high, but the results are near perfect.
-
Here's a quick (53 sec.) ballistic gel test with a Bushmaster AR-15 M4, and the .223... with Federal HP's.
Love that "leetl" bullet... ::)
http://www.youtube.com/watch?v=E13f8lXD0zo
-
Great stuff Kid. To me it looked as though a larger round was used and not a .223. ??? I can't be right all of the time so I stand corrected and humbled. ;) Glad I still own a rifle that can inflict that type of damage if need be.
-
I cant say im sorry if he got shot while drinking. But i do hope they can save his leg.
-
I cant say im sorry if he got shot while drinking. But i do hope they can save his leg.
I got the impression it was the cop with the rifle who was drinking but it was not very clear.
-
I make it a point to be sober and very alert when doing any thing gun related. I do feel bad for the guy because he could lose is job because of a bad decision.
-
just showed that pic to my wife( ortho surgen) she says the guy is screwed. he will lose his knee joint, when they put in metal, she also said maybe even the hip. she also mentioned anytime the feamor brakes it will become compound do to the stress on the bone... then some techical stuff, that I won't even protend to know how to spell or even know what she is talking about.
-
just showed that pic to my wife( ortho surgen) she says the guy is screwed. he will lose his knee joint, when they put in metal, she also said maybe even the hip. she also mentioned anytime the feamor brakes it will become compound do to the stress on the bone... then some techical stuff, that I won't even protend to know how to spell or even know what she is talking about.
::)
-
Math major.......whadareyagonnado?
-
just showed that pic to my wife( ortho surgen) she says the guy is screwed. he will lose his knee joint, when they put in metal, she also said maybe even the hip. she also mentioned anytime the feamor brakes it will become compound do to the stress on the bone... then some techical stuff, that I won't even protend to know how to spell or even know what she is talking about.
TAB,
I just reviewed the films again and I disagree (perhaps you misunderstood your wife's prognosis). The knee joint is not involved and I see no need for a Total Knee Arthroplasty. There is adequate room to apply a distal femoral plate. The fracture is supracondylar (The LISS plate can even be used for intra-articular fractures). There would be no involvement of the hip unless the repair were done with an intramedullary nail. Perhaps that was her recommended repair. I believe that I would go with a Synthes distal femoral LISS plate. The LISS plate is available in 5 to 13 screw length and could be sized to provide adequate stability both above and below the fracture. Just my .02
-
TAB,
I just reviewed the films again and I disagree (perhaps you misunderstood your wife's prognosis). The knee joint is not involved and I see no need for a Total Knee Arthroplasty. There is adequate room to apply a distal femoral plate. The fracture is supracondylar (The LISS plate can even be used for intra-articular fractures). There would be no involvement of the hip unless the repair were done with an intramedullary nail. Perhaps that was her recommended repair. I believe that I would go with a Synthes distal femoral LISS plate. The LISS plate is available in 5 to 13 screw length and could be sized to provide adequate stability both above and below the fracture. Just my .02
Kid "Doc" Shelleen our resident MD
;D
-
I don't have any medical training but I've seen lots of pictures and x-rays of similar wounds. I think Kid is right about a plate fixing the femur.
-
TAB,
I just reviewed the films again and I disagree (perhaps you misunderstood your wife's prognosis). The knee joint is not involved and I see no need for a Total Knee Arthroplasty. There is adequate room to apply a distal femoral plate. The fracture is supracondylar (The LISS plate can even be used for intra-articular fractures). There would be no involvement of the hip unless the repair were done with an intramedullary nail. Perhaps that was her recommended repair. I believe that I would go with a Synthes distal femoral LISS plate. The LISS plate is available in 5 to 13 screw length and could be sized to provide adequate stability both above and below the fracture. Just my .02
Yea! What he said!
;D ;D
-
TAB,
I just reviewed the films again and I disagree (perhaps you misunderstood your wife's prognosis). The knee joint is not involved and I see no need for a Total Knee Arthroplasty. There is adequate room to apply a distal femoral plate. The fracture is supracondylar (The LISS plate can even be used for intra-articular fractures). There would be no involvement of the hip unless the repair were done with an intramedullary nail. Perhaps that was her recommended repair. I believe that I would go with a Synthes distal femoral LISS plate. The LISS plate is available in 5 to 13 screw length and could be sized to provide adequate stability both above and below the fracture. Just my .02
I don't have any medical training but I've seen lots of pictures and x-rays of similar wounds. I think Kid is right about a plate fixing the femur.
Yea! What he said!
;D ;D
I agree with Kid....and no I ain't a medical professional....and didn't stay at a Holiday Inn........
My left thigh looked about like the photo except without an 'entrance wound'.
I had a major compound fracture and actually lost about a 4" section of the bone completely (they never found it and I envisioned a scraggly-assed little mutt running around a neighborhood playing with it). I also lost a good sized chunk of muscle tissue after multiple debridement surgeries over a month to remove trash and tissue.
With the application of an IM Rod (intermedulliary rod ? Kid?) and an application of a new 'bondo-like' substance called 'calcergen paste' to the missing place where the bone was supposed to be, six months later the bone had grown back together (only 3/4" shorter than it once was). My knee was broken in several places, but they saved it.
He may be OK.
-
TAB,
I just reviewed the films again and I disagree (perhaps you misunderstood your wife's prognosis). The knee joint is not involved and I see no need for a Total Knee Arthroplasty. There is adequate room to apply a distal femoral plate. The fracture is supracondylar (The LISS plate can even be used for intra-articular fractures). There would be no involvement of the hip unless the repair were done with an intramedullary nail. Perhaps that was her recommended repair. I believe that I would go with a Synthes distal femoral LISS plate. The LISS plate is available in 5 to 13 screw length and could be sized to provide adequate stability both above and below the fracture. Just my .02
Show off!!!!!!
-
I agree with Kid....and no I ain't a medical professional....and didn't stay at a Holiday Inn........
My left thigh looked about like the photo except without an 'entrance wound'.
I had a major compound fracture and actually lost about a 4" section of the bone completely (they never found it and I envisioned a scraggly-assed little mutt running around a neighborhood playing with it). I also lost a good sized chunk of muscle tissue after multiple debridement surgeries over a month to remove trash and tissue.
With the application of an IM Rod (intermedulliary rod ? Kid?) and an application of a new 'bondo-like' substance called 'calcergen paste' to the missing place where the bone was supposed to be, six months later the bone had grown back together (only 3/4" shorter than it once was). My knee was broken in several places, but they saved it.
He may be OK.
Peg,
It's a bummer that you got to become so knowledgable about orthopedics, the hard way, but you do know your stuff.
Dr. PegLeg, paging Dr. PegLeg.......You are needed in OR 16. ;D
An IM (Intramedullary) rod/nail is often used when there is significant bone loss due to injury. High energy impacts, such as those seen in motorcycle and automobile wrecks, can cause bone loss through disintegration of the bone, a phenomenon that is frequently and irreverantly called, by the non-medical term, dusting. As in, the bone in his mid femur was dusted. Bone fragments can also be ejected with severe open fractures, as you experienced. External fixation devices are also frequently used for severe fractures, with accompanying bone loss and/or difficult alignment. The "Ex-Fix" can be adjusted to accomodate new bone growth
There are many, relatively new, medical products used for bone loss. Other interesting products include: BMP (Bone Morphogenic Protein), DBX (Demineralized Bone Matrix), products made from the calcium found in sea corals, the old standby, Allograft (cadaver bone) and many others (including electronic bone growth stimulators). Many of these products are perfected by the military. There is an unfortunate need for bone replacement due to IEDs. The military is also a leader in the development of new and improved prosthetics.
The U.S. military has a long history of medical innovation.
-
It's not just US military either. the Roman legions used bread mold on wounds, it was not till the 20th century that penicillin was developed from that.
-
Peg,
It's a bummer that you got to become so knowledgable about orthopedics, the hard way, but you do know your stuff.
Dr. PegLeg, paging Dr. PegLeg.......You are needed in OR 16. ;D
An IM (Intramedullary) rod/nail is often used when there is significant bone loss due to injury. High energy impacts, such as those seen in motorcycle and automobile wrecks, can cause bone loss through disintegration of the bone, a phenomenon that is frequently and irreverantly called, by the non-medical term, dusting. As in, the bone in his mid femur was dusted. Bone fragments can also be ejected with severe open fractures, as you experienced. External fixation devices are also frequently used for severe fractures, with accompanying bone loss and/or difficult alignment. The "Ex-Fix" can be adjusted to accomodate new bone growth
There are many, relatively new, medical products used for bone loss. Other interesting products include: BMP (Bone Morphogenic Protein), DBX (Demineralized Bone Matrix), products made from the calcium found in sea corals, the old standby, Allograft (cadaver bone) and many othersn (including electronic bone growth stimulators). Many of these products are perfected by the military. There is an unfortunate need for bone replacement due to IEDs. The military is also a leader in the development of new and improved prosthetics.
The U.S. military has a long history of medical innovation.
Actually, my ortho surgeon used several Army doctors from Ft. Benning in Columbus for a couple of consults.
They also used a new (to our hospital) device called a 'wound-vac'. I know you know what it is, Kid. Our hospital had the machine, but no one had been trained how to use it. They had to get a nurse that worked as a trainer for the manufacturer of the device to come in and train them to use the machine. It was to prevent infection in such large wounds, and to this day all those involved say they have never seen such bad wounds heal so fast with absolutely no signs of infection at all. I was the first person they used it on at our relatively small hospital....but a friend in the OR says they use it all the time now, and have actually saved limbs completely because of it.
Medical treatments, physical rehab, and prosthetics technology has gained great ground in the last few years, but at a very high cost paid by our heroic military personnel.
-
Medical treatments, physical rehab, and prosthetics technology has gained great ground in the last few years, but at a very high cost paid by our heroic military personnel.
Amen PegLeg.
God bless all of our military heroes and their families, who sacrifice right along with them.
The cost of our military medical technology is unbearable and always has been. I would be very happy if the need to innovate disappeared forever.
In the meantime, I'll take triumph from tragedy.
-
TAB,
I just reviewed the films again and I disagree (perhaps you misunderstood your wife's prognosis). The knee joint is not involved and I see no need for a Total Knee Arthroplasty. There is adequate room to apply a distal femoral plate. The fracture is supracondylar (The LISS plate can even be used for intra-articular fractures). There would be no involvement of the hip unless the repair were done with an intramedullary nail. Perhaps that was her recommended repair. I believe that I would go with a Synthes distal femoral LISS plate. The LISS plate is available in 5 to 13 screw length and could be sized to provide adequate stability both above and below the fracture. Just my .02
when she gets all "doctor speak" I just smile and nod. its easier that way. ;)
what I find really intresting is, just about all the surgical tools I have in my garage. they are just wood working to diffrent sizes, shapes and diffrent materails, but other wise they are same
-
when she gets all "doctor speak" I just smile and nod. its easier that way. ;)
what I find really intresting is, just about all the surgical tools I have in my garage. they are just wood working to diffrent sizes, shapes and diffrent materails, but other wise they are same
Don't tell your wife, but back in the day orthopedic surgeons were refered to as "Chrome plated carpenters." ;D
-
Don't tell your wife, but back in the day orthopedic surgeons were refered to as "Chrome plated carpenters." ;D
that will be used at some point. ;D
-
that will be used at some point. ;D
Don't do it. She's an expert with sharp objects and knows where to place them. ;D
-
worth the risk...
in my family, if your not getting teased, something is wrong.
-
worth the risk...
in my family, if your not getting teased, something is wrong.
Just remember, She knows where you sleep ! ;D
-
We use nothing but 316 Stainless Steel Screws in the boat world, get the DeWalt, patch him up, and get him to PT.
In the old days, they would "walk it off"....
;)
Get the exemption for the airports, and his new name is Gimpy... Lucky, guy....I would have thought the leg was gone.
-
no one uses SS, its alosmot always TI.
-
no one uses SS, its alosmot always TI.
My hip implant is cobalt chromium. Don't know that they put in my cheek or eye socket. The newest, longest lasting hip joints are now ceramic.
It's pretty cool stuff, sort of.....
-
7.62 X 39
(http://i217.photobucket.com/albums/cc271/johncrighton/IMGA0725.jpg)
-
Badgersmilk, coyote or a dog with red goo oozing out??? Pass me the nachos and some coffee. I think we are going to have a gore fest and I am hungry. :o
-
Yes sir the 7.62x39 from my sks has done that to many coyotes. Hell i hit one upper right shoulder and found the spine hanging out the side.
-
It's still dead...
:o :o :o :o
Chick with rifle and exploding gophers, no rest... Windy Day...
http://www.youtube.com/watch?v=gxp1lGRS-3I&feature=related
-
My favorite was the badger. ;D
-
Actually, my ortho surgeon used several Army doctors from Ft. Benning in Columbus for a couple of consults.
I once had a urologist that was an ex-Army doctor. Prostate checks with him were a little rough, so when my friends would here my nightmare cystoscopy story, he'd be referred to as Dr. Goldfinger. It was better than the next guy that wanted to be extra thorough. His helicopter technique earned him the name Dr. Bentfinger.