Composition and toxicity of damaging fragments in gunshot and mine-blast spine injuries

Abstract

The feasibility of removing damaging fragments from the spine in gunshot and mine-blast injuries is assessed based on the data of their composition and cytotoxicity. Four damaging fragments removed from the spine and paravertebral tissues were analyzed. Elemental analysis was performed using a scanning electron microscope. The composition of the damaging fragments was studied using spectral analysis. The cytotoxicity of the medium with damaging fragments was evaluated using the methyl tetrazolium test, comparing to the control medium. Morphological changes in cells were assessed using optical light microscopy, comparing to the control. Elemental analysis showed that all studied fragments consisted of alloys of various metals and other chemical elements. During the first few weeks of incubation in a complete nutrient medium, metals underwent fairly active oxidation, producing an orange precipitate. During further incubation, the oxidation of metals continued quite intensively, leading to a change in the nutrient medium and reducing cell proliferation. Moreover, morphological examination showed that cells exposed to metal oxides were rounded, while control sample cells were elongated and spindle-shaped. The methyl tetrazolium test revealed high cytotoxicity of all the fragments studied. All fragments were found to release toxic metal oxides into the nutrient medium, significantly reducing cell viability, regardless of their elemental composition. To prevent complications associated with possible local and/or systemic toxicity of metal fragments, as well as early and late infections, it is recommended to remove projectiles to the maximum extent feasible.

Keywords

mine-blast injuries / gunshot spine injuries / wounding projectile / fragment toxicity / methyl tetrazolium test / elemental analysis of wounding projectiles / scanning electron microscopy / spectral analysis

References

[1] Ricciardi GA, Cabrera JP, Martínez O, et al. AO Spine Latin America Trauma Study Group. Predicting early complications in patients with spinal gunshot wounds: A multicenter study. Brain and Spine. 2024;4:102766. doi: 10.1016/j.bas.2024.102766

[2] Ricciardi G.A., Cabrera J.P., Martínez O., et al. AO Spine Latin America Trauma Study Group. Predicting early complications in patients with spinal gunshot wounds: A multicenter study // Brain and Spine. 2024. Vol. 4. P. 102766. doi: 10.1016/j.bas.2024.102766

[3] Ricciardi GA, Cabrera JP, Martínez O, et al. AO Spine Latin America Trauma Study Group. Predicting early complications in patients with spinal gunshot wounds: A multicenter study. Brain and Spine. 2024;4:102766. doi: 10.1016/j.bas.2024.102766

[4] Zhmur VA. Rendering assistance to the wounded in the spine and spinal cord at various stages of evacuation. In: Experience of Soviet medicine in the Great Patriotic War of 1941–1945. Moscow.1952;11:332–345. (In Russ.)

[5] Жмур В.А. Оказание помощи раненым в позвоночник и спинной мозг на различных этапах эвакуации // Опыт советской медицины в Великой Отечественной войне 1941–1945 гг. Москва, 1952. Т. 11. С. 332–345.

[6] Zhmur VA. Rendering assistance to the wounded in the spine and spinal cord at various stages of evacuation. In: Experience of Soviet medicine in the Great Patriotic War of 1941–1945. Moscow.1952;11:332–345. (In Russ.)

[7] Verkhovsky AI, Khilko VA. Gunshot wounds of the spine and spinal cord. Surgery of the central nervous system. Moscow: Medicine; 1994. P. 264–269. (In Russ.)

[8] Верховский А.И., Хилько В.А. Огнестрельные ранения позвоночника и спинного мозга. Хирургия центральной нервной системы. Москва: Медицина, 1994. С. 264–269.

[9] Verkhovsky AI, Khilko VA. Gunshot wounds of the spine and spinal cord. Surgery of the central nervous system. Moscow: Medicine; 1994. P. 264–269. (In Russ.)

[10] Elkhazh MH, Umarov RM, Bersnev VP, et al. Gunshot combined spinal and craniocerebral injuries. Bulletin of Surgery named after I.I. Grekov. 2009;168(6):56–58. (In Russ.)

[11] Елхаж М.Х., Умаров Р.М., Берснев В.П., и др. Огнестрельные сочетанные спинномозговые и черепно-мозговые ранения // Вестник хирургии им. И.И. Грекова. 2009. Т. 168, № 6. С. 56–58.

[12] Elkhazh MH, Umarov RM, Bersnev VP, et al. Gunshot combined spinal and craniocerebral injuries. Bulletin of Surgery named after I.I. Grekov. 2009;168(6):56–58. (In Russ.)

[13] Manukovskiy VA, Movsisyan AB, Timonin SYu. Urgical treatment of a mine blast wound of the t11 vertebra with anatomical disruption of the spinal cord: a rare clinical case and a brief review of the current literature. Russian Journal of Spine Surgery. 2023;20(4):22–29. (In Russ.) EDN: UMWNTK doi: 10.14531/ss2023.4.22-29

[14] Мануковский В.А., Мовсисян А.Б., Тимонин С.Ю. Хирургическое лечение минно-взрывного ранения Th11 позвонка с анатомическим перерывом спинного мозга: редкий клинический случай и краткий обзор современной ситуации // Хирургия позвоночника. 2023. Т. 20, № 4. С. 22–29. EDN: UMWNTK doi: 10.14531/ss2023.4.22-29

[15] Manukovskiy VA, Movsisyan AB, Timonin SYu. Urgical treatment of a mine blast wound of the t11 vertebra with anatomical disruption of the spinal cord: a rare clinical case and a brief review of the current literature. Russian Journal of Spine Surgery. 2023;20(4):22–29. (In Russ.) EDN: UMWNTK doi: 10.14531/ss2023.4.22-29

[16] Baum GR, Baum JT, Hayward D, MacKay BJ. Gunshot wounds: ballistics, pathology, and treatment recommendations, with a focus on retained bullets. Orthop Res Rev. 2022;14:293–317. doi: 10.2147/ORR.S378278

[17] Baum G.R., Baum J.T., Hayward D., MacKay B.J. Gunshot wounds: ballistics, pathology, and treatment recommendations, with a focus on retained bullets // Orthop Res Rev. 2022. Vol. 14. P. 293–317. doi: 10.2147/ORR.S378278

[18] Baum GR, Baum JT, Hayward D, MacKay BJ. Gunshot wounds: ballistics, pathology, and treatment recommendations, with a focus on retained bullets. Orthop Res Rev. 2022;14:293–317. doi: 10.2147/ORR.S378278

[19] Trishkin DV, Kryukov EV, Alekseev DE, et al. Military field surgery. National Manual. 2nd ed. rev. and suppl. Moscow: GEOTAR-Media; 2024. 1056 p. (In Russ.) EDN: AYGYWM doi: 10.33029/9704-8036-6-VPX-2024-1-1056

[20] Тришкин Д.В., Крюков Е.В., Алексеев Д.Е., и др. Военно-полевая хирургия. Национальное руководство. 2-е изд. перераб. и доп. Москва: ГЕОТАР-Медиа, 2024. 1056 с. EDN: AYGYWM doi: 10.33029/9704-8036-6-VPX-2024-1-1056

[21] Trishkin DV, Kryukov EV, Alekseev DE, et al. Military field surgery. National Manual. 2nd ed. rev. and suppl. Moscow: GEOTAR-Media; 2024. 1056 p. (In Russ.) EDN: AYGYWM doi: 10.33029/9704-8036-6-VPX-2024-1-1056

[22] Samokhvalov IM, Kryukov EV, Markevich VYu, et al. Ten surgical lessons from the initial stages of a military operation. Military Medical Journal. 2023;344(3):4–10. (In Russ.) EDN: DSYIAP doi: 10.52424/00269050_2023_344_4_4

[23] Самохвалов И.М., Крюков Е.В., Маркевич В.Ю., и др. Десять хирургических уроков начального этапа военной операции // Военно- медицинский журнал. 2023. Т. 344, № 4. С. 4–10. EDN: DSYIAP doi: 10.52424/00269050_2023_344_4_4

[24] Samokhvalov IM, Kryukov EV, Markevich VYu, et al. Ten surgical lessons from the initial stages of a military operation. Military Medical Journal. 2023;344(3):4–10. (In Russ.) EDN: DSYIAP doi: 10.52424/00269050_2023_344_4_4

[25] Kalinich JF, Emond CA, Dalton TK, et al. Embedded weaponsgrade tungsten alloy shrapnel rapidly induces metastatic highgrade rhabdomyosarcomas in F344 rats. Environ Health Perspect. 2005;113(6):729–34. doi: 10.1289/ehp.7791

[26] Kalinich J.F., Emond C.A., Dalton T.K., et al. Embedded weaponsgrade tungsten alloy shrapnel rapidly induces metastatic highgrade rhabdomyosarcomas in F344 rats // Environ Health Perspect. 2005. Vol. 113, N 6. P. 729–734. doi: 10.1289/ehp.7791

[27] Kalinich JF, Emond CA, Dalton TK, et al. Embedded weaponsgrade tungsten alloy shrapnel rapidly induces metastatic highgrade rhabdomyosarcomas in F344 rats. Environ Health Perspect. 2005;113(6):729–34. doi: 10.1289/ehp.7791

[28] Kalinich JF, Kasper CE. Are internalized metals a long-term health hazard for military veterans? Public Health Rep. 2016;131(6): 831–833. doi: 10.1177/0033354916669324

[29] Kalinich J.F., Kasper C.E. Are internalized metals a long-term health hazard for military veterans? // Public Health Rep. 2016. Vol. 131, N 6. P. 831–833. doi: 10.1177/0033354916669324

[30] Kalinich JF, Kasper CE. Are internalized metals a long-term health hazard for military veterans? Public Health Rep. 2016;131(6): 831–833. doi: 10.1177/0033354916669324

[31] Yen JS, Yen TH. Lead poisoning induced by gunshot injury with retained bullet fragments. QJM. 2021;114(12):873–874. doi: 10.1093/qjmed/hcab144

[32] Yen J.S., Yen T.H. Lead poisoning induced by gunshot injury with retained bullet fragments // QJM. 2021. Vol. 114, N 12. P. 873–874. doi: 10.1093/qjmed/hcab144

[33] Yen JS, Yen TH. Lead poisoning induced by gunshot injury with retained bullet fragments. QJM. 2021;114(12):873–874. doi: 10.1093/qjmed/hcab144

[34] Ghasemi M, Turnbull T, Sebastian S, Kempson I. The MTT assay: utility, limitations, pitfalls, and interpretation in bulk and single-cell analysis. Int J Mol Sci. 2021;22(23):12827. doi: 10.3390/ijms222312827

[35] Ghasemi M., Turnbull T., Sebastian S., Kempson I. The MTT assay: utility, limitations, pitfalls, and interpretation in bulk and single-cell analysis // Int J Mol Sci. 2021. Vol. 22. N 23. P. 12827. doi: 10.3390/ijms222312827

[36] Ghasemi M, Turnbull T, Sebastian S, Kempson I. The MTT assay: utility, limitations, pitfalls, and interpretation in bulk and single-cell analysis. Int J Mol Sci. 2021;22(23):12827. doi: 10.3390/ijms222312827

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