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INTRODUCTION

The mechanisms of injury from gunshot have been categorized[4] into four distinct processes: i) direct missile contact with tissue, causing disruption of the tissue; ii) high over-pressure in the immediate vicinity of the projectile, which crushes the tissue; iii) expansion of the temporary cavity after passage of the projectile, stretching and tearing tissue, and iv) Rayleigh-Taylor instability of the temporary cavity upon collapse, tearing and disrupting the cavity wall. Laboratory experiments with animals[5]-[7] have demonstrated that gunshot injury can occur in tissue remote from the trajectory of the missile. It has been demonstrated[5] that remote injury correlates with measurements of pressure waves generated by bullet impact. However, this mechanism has been disputed[8] on the grounds that in early experiments[9] no injury to human red blood corpuscles or whole frog hearts due to the pressure waves generated by the passage of bullets was observed. On the other hand, it has been shown[10] that cultures of nerve cells which are far enough from bullet trajectories that they are not directly involved in the temporary cavity suffer delayed injury. Subsequently it was also shown[11] that nerve cells are more vulnerable to remote injury than other types of cells. We present a case in which a localized spinal cord injury followed a gunshot wound without entry of bullet fragments into the spinal canal. We postulate that wave focusing by thoracic vertebrae can concentrate energy into the spinal canal, with consequent injury to the spinal cord.
brad@galcit.caltech.edu

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