PF Hill, DP Edwards, GW Bowyer. Small Fragment Wounds: Biophysics, Pathophysiology and Principles of Management.

Military surgical doctrine has traditionally taught that all ballistic wounds should be formally managed by surgical intervention. There is now, however, both experimental and clinical evidence supporting the nonoperative treatment of selected small fragment wounds. Low energytransfer wounds affecting the soft tissues, without neuro-vascular compromise and with stable fracture patterns, may be suitable for early antibiotic treatment.The management of ballistic wounds to the gastrointestinal tract requires surgical intervention but, advances in the treatment of these wounds, especially those involving the colon, may allow more effective treatment with a reduced morbidity. Introduction The most common wounds in modern warfare are caused by fragmenting munitions such as artillery shells, mortar bombs and grenades, rather than bullets (Table 1) (Ryan et al 1991). Table 1. Distribution of wounding agents in casualties for wars and campaigns this century (%). (Ryan et al. 1991). Israeli figures are complicated by inclusion of psychiatric casualties in the group designated