ABSTRACT
The amount of energy imparted to a fracture is an important consideration during assessment. The more energy imparted to the fracture, the larger amount of bone and soft tissue compromised. Gunshot wounds are good examples of this effect.13 A 0.22 long rifle round often has a 2.6 g lead slug and a muzzle velocity of 370 m/s with an energy of 141 J. By comparison, a 0.223 caliber (5.56 × 45 mm) round has a 2 g bullet, but a muzzle velocity of 1,140 m/s and an energy of 1.524 J. For a comparable size of slug, the second round has over ten times the energy of the first. In low velocity gunshot wounds, the fracture is treated essentially as a closed fracture.12 In contrast, high velocity gunshot wounds must be treated as grade III open fractures. These carry a much greater risk of infection, nonunion, and soft tissue damage. Nerve damage is frequent. The wound must be debrided and copiously lavaged. The wound is often left open.
