Gun Shot Wound (Full Version)

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Alex Brenner PT MPT OCS -> Gun Shot Wound (June 19, 2005 11:03:00 PM)

Small arms fire to left foot. Entry wound on lateral dorsum of foot, exit at the plantar aspect of the foot just distal to calcaneous. Which bone structures were damaged?

All images obtained and used with permission.

[image]http://img.photobucket.com/albums/v85/brennerak/GunshotwoundfootAP.jpg[/image]

[image]http://img.photobucket.com/albums/v85/brennerak/Gunshotwoundfootlat.jpg[/image]



pablo w -> Re: Gun Shot Wound (June 19, 2005 11:39:00 PM)

Looks like the base of the 5th metatarsal and the cuboid.

Pablo



certMDT -> Re: Gun Shot Wound (June 20, 2005 3:39:00 AM)

Agree completely with Pablo. A side question - is it the view, or are those sesamoids more lateral than usual?

Charlie



USAPT -> Re: Gun Shot Wound (June 20, 2005 3:45:00 AM)

5th MTP, cuboid, and looks like a small fragment of the calcaneous



JLS_PT_OCS -> Re: Gun Shot Wound (June 20, 2005 4:21:00 AM)

Agree with above.
Charles, it looks like there is some HAV going on there also, which may account for the sesamoid position.

Alex, was this self-inflicted? Awfully small hole (close range) with clean entry/exit, looks like about a 5.56mm rifle round to me...

J



Alex Brenner PT MPT OCS -> Re: Gun Shot Wound (June 20, 2005 6:13:00 AM)

This guy is being seen by us right now. He says that he was shot by the bad guys and has the purple heart to prove it. He and several others were shot up recently, you may have read about it in the news. I don't know if it was close range but I will ask him.

The bad guys are using AK-47s right now, isn't that close to 5.56mm?



jma -> Re: Gun Shot Wound (June 20, 2005 8:04:00 AM)

Looks like the proximal head of the 5th MTP jint and the cuboid is involved here.



Synergy -> Re: Gun Shot Wound (June 20, 2005 9:17:00 AM)

I believe AK-47s are 7.62 x 39...are they not? Either way, I agree with the above posts as far as bone structure involvement.



dragonfire -> Re: Gun Shot Wound (June 20, 2005 8:34:00 PM)

alex,
the films are showing the view of the foot clockwise: dorsum, dorsolateral, and medial. correct me if i'm wrong.

jason,
what's HAV?



Jeep -> Re: Gun Shot Wound (June 21, 2005 1:38:00 AM)

Dragon-
The views in order are: AP(anteroposterior), oblique, and lateral.

I think the location of the sesamoids is due to positioning and clinically unremarkable.



JLS_PT_OCS -> Re: Gun Shot Wound (June 21, 2005 2:58:00 AM)

Dragon-
Hallux AbductoValgus (a bunion).

Chris is right, the AK series is a 7.62mm round.

J



chiroortho -> Re: Gun Shot Wound (June 21, 2005 3:48:00 AM)

Have to ask...was this soldier left-handed? Also, how was he shot? Seems to me that if he was shot from the side, the projectile would have traveled across his foot, not vertically.

And a .308-sized bullet can do some damage.

The sesamoids are normal, I know, they do look displaced but they almost always look displaced.



JLS_PT_OCS -> Re: Gun Shot Wound (June 21, 2005 4:49:00 AM)

Soldiers often are moving to avoid fire and dropping to the ground, standing back up, and rushing from cover to cover while engaged in a firefight. (Thankfully, i've only done this in training)
It would be simply a matter of chance for the round to strike him at any point in that sequence.
Could be worse, though...

J



Jeep -> Re: Gun Shot Wound (June 21, 2005 4:57:00 AM)

I see no evidence of valgus displacement of the great toe(bunion), on the submited films.

Chirortho- Agreed- no two films are going to have the sesamoids exactly the same, and depending on the technical component(positioning) there can be a wide range of x-ray appearances.



chiroortho -> Re: Gun Shot Wound (June 21, 2005 5:50:00 AM)

Yeah Jason, I wasn't thinking about that. Makes sense.



dragonfire -> Re: Gun Shot Wound (June 21, 2005 8:26:00 AM)

i'm so happy i got 2 out of 3! this is coming from someone who have not gone through any radiology course in or out of school.

i enjoy reading this forum! looking at the films and reading the threads educate me for what i was not priviledged to have in school.

i will sure keep reading this forum!



Alex Brenner PT MPT OCS -> Re: Gun Shot Wound (June 21, 2005 10:35:00 PM)

Dragon,
Jeep is correct on the images, AP, Oblique, lateral.

Greg,
This is a current patient we are seeing. His unit was ambushed and he dove behind a rock after they started taking fire. His legs were sticking out from behind the rock. The round actually came down the lateral tibia just slightly cutting the skin along the tibial shaft and lateral compartment and entered the lateral foot. It was a 7.62mm round.



chiroortho -> Re: Gun Shot Wound (June 22, 2005 5:15:00 AM)

Ouch! I know you'll take great care of him Alex.



Alex Brenner PT MPT OCS -> Re: Gun Shot Wound (June 23, 2005 8:38:00 PM)

There is a comminuted fracture of the left cuboid and fracture to the base of the 5th metatarsal.

Good job Chris recognizing the correct ballistics. :)


God bless these young men and women that are in harms way providing selfless sacrifice.

[IMG]http://img.photobucket.com/albums/v85/brennerak/GunshotwoundfootAPedit.jpg[/IMG]



Synergy -> Re: Gun Shot Wound (June 24, 2005 2:36:00 PM)

I wholeheartedly agree completely with your last sentence Alex!

Identifying the 'round' was pretty easy because I have an AK-47, SKS, and a modified MAC-90...all of which use 7.62x39 rounds.



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