Help Identifying Bullet (From Xray)

[Doc_Glock]

A fellow surgeon posted the following Xray for a patient who walked into their clinic asking for ideas on how to address the Humerus fracture. I thought it might be interesting to the folks here and had some questions of my own outside of the medical treatment.

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I don’t know the treating physician, but suspect this is an OCONUS, possibly Kurdistan and likely with a military rifle.

The disintegration of the humerus is impressive. The injury is described as having only an entry wound and having the nerves and vasculature to the arm intact.

I see some sort of penetrating bullet tip that is intact in the Xray. The rest of the bullet has completely fragmented.

Any idea what sort of cartridge and bullet this is?

Is this typical bony destruction one can see with small caliber, high velocity rifle injuries?

[Jim Watson]

5.56 mm M855 (FN SS109) bullet has a steel front core and a lead rear core in the usual copper alloy jacket. The triangular image in the x-ray might be that steel cone, with fragments of lead and copper scattered all over.

[Doc_Glock]

5.56 mm M855 (FN SS109) bullet has a steel front core and a lead rear core in the usual copper alloy jacket. The triangular image in the x-ray might be that steel cone, with fragments of lead and copper scattered all over.

I suppose the Russians would field something similar as well?

[Jim Watson]

Can't find plans for Com bloc bullets.

[Wondering Beard]

I suppose the Russians would field something similar as well?

5.45 7N6 had a steel rod penetrator but I'm not sure it would look like the cone in the Xray.

Here are the newer ammo variants that the Russians could be fielding: 5.45×39mm cartridge variants (https://en.wikipedia.org/wiki/5.45%C3%9739mm#5.45%C3%9739mm_cartridge_variants)

You say this might be from Kurdistan and there are a whole lot of calibers used over there, as I understand it, not just the classic Russian and US ones.

[witchking777]

Green tip. I'm 100% sure. I've got a penetrator pin that looks exactly like that from my own ballistic tests. That and a the lead fragments after hitting a bone.

[Dr_Thanatos]

A fellow surgeon posted the following Xray for a patient who walked into their clinic asking for ideas on how to address the Humerus fracture. I thought it might be interesting to the folks here and had some questions of my own outside of the medical treatment.

57604

I don’t know the treating physician, but suspect this is an OCONUS, possibly Kurdistan and likely with a military rifle.

The disintegration of the humerus is impressive. The injury is described as having only an entry wound and having the nerves and vasculature to the arm intact.

I see some sort of penetrating bullet tip that is intact in the Xray. The rest of the bullet has completely fragmented.

Any idea what sort of cartridge and bullet this is?

Is this typical bony destruction one can see with small caliber, high velocity rifle injuries?

The bony destruction is absolutely typical for a high velocity rifle injury. .223/5.56 usually doesn't look that impressive vs. a long bone, at least the ones I see don't. I would actually be a little bit suspicious of a slightly larger or different caliber.

[Wayne Dobbs]

I think it's the penetrator/nose cone from an M855A1 round. Maybe DocGKR can opine on that.

[HCM]

I suppose the Russians would field something similar as well?

Russian 5.45 rounds have different construction than SS109 green tip.

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57631

The bullet tip in your x Ray appears to be a penetrator from M855 or M855A1.

Given the copious numbers of M16A2s provided to the Iraqi army as military aid and the number diverted to black market sales and captured by ISIS the round is not really indicative of who might have fired it.

[45dotACP]

The bony destruction is absolutely typical for a high velocity rifle injury. .223/5.56 usually doesn't look that impressive vs. a long bone, at least the ones I see don't. I would actually be a little bit suspicious of a slightly larger or different caliber.That the nerves and blood vessels were OK was fascinating enough to me. Would it be more typical of a person in a developing nation to have weaker/more brittle bones due to nutritional deficits? Perhaps that explains the dramatic difference from your patients (who are presumably at least not malnourished).

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[Dr_Thanatos]

That the nerves and blood vessels were OK was fascinating enough to me. Would it be more typical of a person in a developing nation to have weaker/more brittle bones due to nutritional deficits? Perhaps that explains the dramatic difference from your patients (who are presumably at least not malnourished).

Sent from my moto g(6) using Tapatalk

Good questions, I don't have answers. Doc_Glock might be able to suggest demineralization of the bone from the X-ray. I can't.


57635

That is a humerus hit with two 5.56 rounds. Both entered very close to the target, no intermediate targets and no bony injuries before they hit the humerus. I think everyone can see the difference. That's why I was wondering if that bullet is something that had a bit more ooomph to it.

[Malamute]

Would the velocity difference between an M4 length gun vs a 20" barreled A2/A4 type gun account for any difference in effect?

[DocGKR]

Looks a lot like an M855 "green tip" penetrator; A1 is a different shape.

[Chuck Haggard]

Was the scapula also involved?

[Doc_Glock]

There is conjecture amongst my upper extremity surgery colleagues that there could have been a pre existing bone tumor or something to explain the outstanding bone loss. I think that is probably a reach, but anything is possible.

Unfortunately the doc who posted the Xray has gone completely dark. I will give more details when available.

[Doc_Glock]

Was the scapula also involved?

No idea. Sorry. My information is very limited. It’s just an amazing film.

[awp_101]

That first X-ray looks like the kind of damage I’ve always pictured when reading about the damage a Minie ball would do when it hit bone.

Could that arm be salvaged and made functional again? Either in Whateverstan or here?

[Doc_Glock]

That first X-ray looks like the kind of damage I’ve always pictured when reading about the damage a Minie ball would do when it hit bone.

Could that arm be salvaged and made functional again? Either in Whateverstan or here?


That is the question. There is debate over watch and wait to see if it will mineralize versus free fibula grafting. In a rustic environment he’s likely in a sling for a good long time.

[Caballoflaco]

I’d be curious to see where the entrance wound was and if it was round, or if maybe the bullet hit the bone lengthways rather than point on. It does kinda looks like there is a “hole” at the bottom of the head. But I’m also completely untrained in reading x-rays and not a medical professional.

[EzGoingKev]

If that happened in CONUS what would be the course of treatment for that?

[Doc_Glock]

If that happened in CONUS what would be the course of treatment for that?

Take the fibula bone out of the leg and use it to replace humerus.

[Dr_Thanatos]

There is conjecture amongst my upper extremity surgery colleagues that there could have been a pre existing bone tumor or something to explain the outstanding bone loss. I think that is probably a reach, but anything is possible.

Unfortunately the doc who posted the Xray has gone completely dark. I will give more details when available.

What about hitting an ABC? I'd buy that...

[Doc_Glock]

What about hitting an ABC? I'd buy that...

I am not familiar with the term "ABC?"

[EzGoingKev]

Take the fibula bone out of the leg and use it to replace humerus.
I am not a doctor so IDK if you are kidding or not, but the none doctor in me says WTF does the leg do now that it is missing a bone?

[HCM]

I am not a doctor so IDK if you are kidding or not, but the none doctor in me says WTF does the leg do now that it is missing a bone?

Parts is parts.

[Doc_Glock]

I am not a doctor so IDK if you are kidding or not, but the none doctor in me says WTF does the leg do now that it is missing a bone?

Two bones in lower leg. It can get along.

https://www.microsurgeon.org/fibulaflap

[Dr_Thanatos]

I am not familiar with the term "ABC?"

Sorry, shorthand.

Aneurysmal Bone Cyst. It's also a good location for a simple cyst, but he might not be a good age. Both could account for abnormal bone in the location of the bullet injury.

[TiroFijo]

Take the fibula bone out of the leg and use it to replace humerus.

Fascinating that an arm with such an horrendous injury can be saved.

What is the success rate in such procedures?

[chances R]

Long time Ortho PA. ABC is a reasonable possibility. Common location and typical appearance. While the bullet fragmented, it wouldn't produce that kind of bony void. Looks like impact was more in the anatomical neck and shattered the glenoid as well. Abduction splint may give better alignment and like most ABCs the trauma may induce more healing. The problem will be the loss of motion and probable fusion of the glenoid with the humerus. Interesting to be able to follow progress, but can see a reverse total joint after initial healing.

[EzGoingKev]

Long time Ortho PA. ABC is a reasonable possibility. Common location and typical appearance. While the bullet fragmented, it wouldn't produce that kind of bony void. Looks like impact was more in the anatomical neck and shattered the glenoid as well. Abduction splint may give better alignment and like most ABCs the trauma may induce more healing. The problem will be the loss of motion and probable fusion of the glenoid with the humerus. Interesting to be able to follow progress, but can see a reverse total joint after initial healing.
Would you please provide us with a medical cliff notes for dummies on that?

[chances R]

Long time Ortho PA. ABC is a reasonable possibility. Common location and typical appearance. While the bullet fragmented, it wouldn't produce that kind of bony void. Looks like impact was more in the anatomical neck and shattered the glenoid as well. Abduction splint may give better alignment and like most ABCs the trauma may induce more healing. The problem will be the loss of motion and probable fusion of the glenoid with the humerus. Interesting to be able to follow progress, but can see a reverse total joint after initial healing.


Would you please provide us with a medical cliff notes for dummies on that?

Ok. The large dark area in the upper arm bone (humerus) does not appear to be of normal structure/consistancy, hence probable a cyst inside the bone (ABC) which is not unusual. There are two primary breaks in the bone. One is in the shaft of the bone and with multiple small fragments around that same area. It is bent or angulated. Will still heal most likely, but not in perfect position. There are also breaks at what looks to be the primary point of impact at the 'ball' of the shoulder joint. Also several fragments and it looks like the 'cup' or glenoid that articulates with the ball is also broken. The breaks around the joint may actually fuse together during the healing process. Of course all is subject to what medical care is available, along with luck, good and bad. Here in the good USA still a terrible injury, worse without advanced care. Concern for infection, poor alignment, not healing at all, amputation, etc. Interesting from my side of the table, terrible from the patients side. At some point a joint replacement would probably be the best end result. Just discussing and thinking out loud.