Presentation
Young man brought to emergency department after being shot on the head.
Patient Data
The metal bullet made a transverse trajectory from left to right through the supraorbital margin of the frontal bone, involving the frontal sinus and frontoethmoidal recess. Bullet's course is predicted by the destruction of local bone structures and by the metallic foreign bodies (bullet fragments). The bullet is located in the soft tissues lateral to the right lower portion of the frontal bone. There are small bullet fragments deflected into frontal lobes causing brain injury.
Case Discussion
Bullet fragmentation generally occurs on impact of a non-jacketed or semi-jacketed bullet to a body structure, frontal bone in this case. Besides giving some clue to the bullet characteristics, fragmentation often leads to a telltale distribution of fragments spreading along the bullet course, giving an important information about the mechanism and direction of injury.