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Refer to: Wilson JM: Shotgun ballistics and shotgun injuries (Trauma Rounds-San Francisco General Hospital). Trauma West J Med 129:149-155, Aug 1978 Rounds Chief Discussant JAMES M. WILSON, MD Editors Shotgun Ballistics and DONALD D. TRUNKEY, MD Shotgun F. WILLIAM BLAISDELL, MD Injuries This is one of a series of Confer- ences on Trauma at San Francisco General Hospital IAN LEVERTON, MD: * The patient is a 25-year- liver and omentum were seen. The tenth rib was old white man who was admitted to the emer- shattered, producing a large tangential diaphrag- gency department 20 minutes after having been matic defect. The diaphragm was repaired, the shot in the right lateral thorax and right thigh with liver lacerations which were not bleeding were a 12-gauge shotgun. The estimated range was 5 drained posteriorly, and bleeding points in the to 10 yards; the empty shell casings at the scene omentum were controlled. Local debridement of confirmed the gauge and the fact that 00 buck- the entrance wounds was also carried out. Simul- shot had been the load. Upon physical examina- taneous exploration of the thigh showed a totally tion, the patient was conscious and had a blood transected superficial femoral artery. The dam- pressure of 70 systolic, a pulse of 120 and respi- aged segment was resected and primary anasto- ration of 34. There were multiple pellet holes in mosis was carried out. Soft tissue debridement the right lateral thorax and right upper quadrant was done and an angiogram taken. Arteriography with injuries of the left forearm and left hand as showed patent anastomosis but narrowing of the well. There were multiple pellet holes in the right vessels in the thigh. The patient was placed in lateral thigh with an obvious fracture of the right skeletal traction and transferred to the intensive femur. There were no pulses distal to the blast care unit. area in the thigh, and the foot was cold and The patient's course was relatively benign and ischemic. he was transferred from the intensive cate unit Cutdowns were carried out in the left arm and on the sixth postinjury day. At present he is being left leg, and Ringer lactate was infused rapidly. managed in traction for his femur injury. Blood was drawn and sent for typing and cross matching, and x-ray films of the femur, abdomen F. WILLIAM BLAISDELL, MD: t I would like to and chest were taken en route to the operating introduce our chief trauma resident, Dr. James room. At operation, four tangential wounds of the Wilson, who during several years in the navy did research on ballistics and char- Sponsored by the American College of Surgeons Northern special wounding California Trauma Committee. Supported in part by NIH Grant acteristics of missiles. Dr. would you GM 18470. Wilson, *Junior resident in surgery, San Francisco General Hospital. Reprint requests should be sent to: Donald D. Trunkey, MD, tFormer Chief, Surgical Service, San Francisco General Hos- Department of Surgery (3A), San Francisco General Hospital, pital. He is now Professor and Chairman, Department of Surgery, 1001 Potrero Avenue, San Francisco, CA 94110. University of California, Davis, School of Medicine. THE WESTERN JOURNAL OF MEDICINE 149 TRAUMA ROUNDS comment on the nature of shotgun injuries and TABLE 1.-Common Shotgun Gauges and principles of their management? Corresponding Calibers JAMES M. WILSON, MD:* If one were to 10 gauge ... ... 0.775 caliber analyze 12 gauge ... ... 0.730 caliber the factors most strongly influencing patient fa- 16 gauge .-. ...... 0.670 caliber tality following gunshot wounds in the civilian 20 gauge ... ... 0.615 caliber population, it would become immediately appar- 28 gauge ... ... 0.550 caliber 410 ... ... 0.410 caliber ent that the type of weapon used is key, and that shotguns are responsible for a greater percentage of deaths than are any other type of firearm. ating excessive pressures whereas Shultz's powder Shotgun wounds are different from rifle and pistol which burned slower was made from nitrated wounds and by no means can be considered wood pulp, using a method which duPont later identical either from a ballistics standpoint or in used for many years in the United States. wounding capability. Modern shot of uniform quality was developed by the Englishman William Watts in 1769. He Shotguns are popular worldwide; more of these dropped specific amounts of hot lead into a smooth-bore weapons are bought and used than column of water, thus producing lead pellets. are rifled types. In fact, many governments-such As mentioned earlier, modern shotguns are as those of Great Britain and the Soviet Union- smooth bore-that is, the barrels are smooth discourage the use of rifles yet allow unrestricted without any rifling or grooving. Shotguns come in use of shotguns. almost every form imaginable: single shot, double- The idea of using a blast of small pellets for barreled side-by-side, double-barreled over-and- hunting and even for fighting is as old as the use under, pump action or semiautomatic. The Win- of firearms itself. The first guns were smooth bore chester Model 97 pump action shotguns were or unrifled and as a result were grossly inaccurate. used by American troops in short barrel form Rifling, or the grooving of the gunbarrel to pro- during World War I. A similar gun was used in duce spinning of the projectile, was not developed World War II and in Vietnam for jungle fight- until about 1500-some 150 years after gun- ing. Police have used this same riot gun-a 12 powder was first used as propellant. Early Ameri- gauge with a sawed-off (20-inch) barrel loaded can colonists began to use buckshot loads in their with double 0 buckshot. The advantages of this flintlock muskets because the general accuracy of gun as a close range weapon will be made clear the smooth bore barrel veapons was so poor. Use later in this text. of buckshot also made it easier to hit moving The gauge (or bore caliber) for a shotgun is targets or those in brush, where quick shooting designated differently than for a rifle or pistol. The was essential for acquiring food or for protection. classification system is antiquated, dating back Modern shotguns date back to about 1750 to muzzle loading days. At that time, the gauge when flintlock, and later percussion, caps were of a musket was expressed in terms of how many used. The LeFaucheaux pinfire was patented in lead balls of an appropriate size would be re- 1836; this type of shell is still made and used in quired to weigh one pound. Therefore, a 12- certain parts of Europe. -In 1851 Charles Lan- gauge weapon originally had a bore of such caster of England developed an improved cen- diameter that a round lead ball weighing 1/12 terfire breech-loading shotgun-a development pound could enter the barrel. This system of which marked the end of the muzzle-loader era. designation has persisted to modern times al- Choke boring, or the narrowing of the end of the though there are two exceptions to the system: barrel to improve target coverage by pellets, was the 9-mm shotshell which has, indeed, a 9-mm little known or used until about 1870. In that bore, and the 0.410 gauge which is actually 0.410 year, Fred Kimble of the United States developed caliber; that is, 0.410 inches in diameter. The it to near its present form. common shotgun gauges are shown in Table 1 In relation to powder charge, the first com- with their corresponding calibers. mercially successful smokeless powder was de- The larger gauge guns-4, 8 and 10 gauge- veloped in 1864 by a Prussian, Captain E. Shultz. have essentially disappeared from popular use Earlier smokeless powder burned too fast, gener- since the advent of higher grade smokeless pow- der and of choke boring, which notably improved *Senior Resident, Surgical Service, San Francisco General Hos- pital. the performance of the smaller gauge weapons. 150 AUGUST 1978 * 129 * 2 TRAUMA ROUNDP The 12 gauge is by far the most popular shotgun One additional point about the powder de- ever used in the United States for civilian sports serves comment. As aforementioned, shotgun and for military, police and criminal use. Indeed, powder is quite fast burning and is designed for more than half of the shotguns sold in this coun- use only in shotguns where relatively low cham- try each year are 12-gauge weapons. The 12, 16, ber pressures are generated. As a result, serious 20 and 410 gauge are extensively manufactured injury will be inflicted if this powder is used by and used in the United States but the advantages novices in home-loading rifle or pistol cartridges. of each are a function only of personal prefer- The shot, then, is a collection of individual ence, as we will show in the discussion on bal- pellets. They were once made of pure lead but listic characteristics which follows. are now usually made of a lead and antimony The choke of a given shotgun designates the alloy. Problems with pellet deformity and' fouling amount of constriction at the end of the weapon of the barrel subsequently led to the practice of barrel, and it is the choke' that actually deter- coating the pellets with a copper-zinc alloy. This mines the shot pattern at a given distance from coating is especially common in magnum loads. the muzzle. The constriction acts much like the The pellets come in various sizes and are nozzle on a garden hose which, when partially loaded into the shot shells usually in increments constricted, gives a nar'row stream of water for of approximately one ounce.

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