Penetrating thoracic wounds caused by plastic bullets

J Thorac Cardiovasc Surg. 1992 Feb;103(2):381-5.


Thoracic penetrating injuries caused by a new plastic bullet were studied to determine the nature of the wounds and the appropriate management. Twenty-six casualties from the Israeli-Palestinian conflict (Intifada) were included. The organs most commonly involved were lung (n = 21), bony chest wall (n = 9), heart (n = 3), and diaphragm. Bleeding was at least moderate in 20 patients, amounting in all patients to an average of 975 ml. Thoracotomy was required in 11 patients (42%) mainly because of cardiac injury (n = 3) and aortic or other arterial bleeding (n = 3). Simple oversewing of severed organs (n = 8) or ligation of bleeding vessels (n = 3) was satisfactory. Two patients died (7.7% mortality); one after major liver resection; the other was dead on arrival. We conclude that plastic bullets have a linear course unless displaced by the bony chest wall, when they tend to fragment and cause simple fractures. Fired from a presumed range of at least 70 m, plastic bullets behave like low-velocity missiles, and tissue destruction is minimal. Management should be similar to that of civilian thoracic penetrating trauma.

MeSH terms

  • Adolescent
  • Adult
  • Humans
  • Male
  • Plastics
  • Radiography
  • Thoracic Injuries / diagnostic imaging
  • Thoracic Injuries / pathology*
  • Thoracic Injuries / therapy
  • Wounds, Gunshot / diagnostic imaging
  • Wounds, Gunshot / pathology*
  • Wounds, Gunshot / therapy


  • Plastics