Wound ballistics, surgery and the law of war

Wound ballistics is a science which can relate to other disciplines such as law, design of weapons, forensic pathology and surgery. We present an approach to wound ballistics which should make this complex subject accessible to and understandable by surgeons. There are two major contributions made by the science of wound ballistics to the surgical management of war-wounded people. The first is the demonstration of the transfer of kinetic energy from the projectile to the tissues along the projectile's track (‘down-track’); this explains the heterogeneity of war wounds. The ‘down-track’ deposit of energy of a projectile is determined principally by the mass and velocity of the projectile and also, in the case of a bullet, by its construction and stability in flight. The rate with which energy is transferred determines the amount of tissue damage. If surgeons recognize the heterogeneity of wounds they can adopt appropriate management strategies for each individual wounded person. However, guidelines for surgeons as to which or how much tissue should be excised from a war wound have not yet been generated from wound ballistics studies. The second contribution pertains to fractures; the transfer of energy from the projectile to the bone and its surrounding soft tissues has important implications for fracture management. A comminuted fracture may result from low energy transfer. The extent of soft tissue damage surrounding a fracture influences the excision of the wound and the choice of fracture holding. In the context of the law of war and, in particular, the Hague Declaration of 1899, we propose that ‘down-track’ deposit of energy as opposed to technical consideration of bullet construction should be a starting point for legal debate about weapons.