Head Wounds

In skull wounds, as elsewhere in bone gunshot fractures, inward beveling of the calvarial defect at the bullet entrance and outward beveling of the skull at the exit wound are typical.23 This is due partly to the geometry of the skull and partly to the bullet-bone interaction. Characteristic fracture patterns of the skull can be used to identify entrance and exit wounds.23 When there is a cranial exit wound, skull fractures propagate across the calvarium faster than the bullet travels through the brain, producing characteristic patterns of fracture. These fracture patterns sometimes allow differentiation of entrance and exit wounds. 23 Radial fractures often spread out in a star pattern from the entrance and to a lesser extent from the exit holes in the skull. Concentric heaving fractures may occur, connecting the arcs of the radial fractures around both the entrance and exit holes, if sufficient temporary cavitation forces are generated inside the brain to cause significant outwardly directed tissue splash forces inside the skull, pushing out the calvarium.23 Because a fracture will not cross a preexisting fracture line, the temporal sequence of the occurrence of the fractures can sometimes be determined from the pattern of the fractures.

Brain, whose tissue properties include near-water density, very little elasticity, and poor tissue cohesiveness, is extremely sensitive to temporary cavitation forces. When disrupted by such forces, severe brain injury often results. In addition to the relative lack of elasticity of brain tissue, its enclosure in the rigid cranial vault magnifies brain disruption by temporary cavitation forces.

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