Unusual ignition of a bullet causing hand injury: Case report

Abstract

Gun-cleaning accidents occur rarely. Gun-cleaning mistakes can cause accidents and even fatalities. The most dangerous type of gun-cleaning mistake is forgetting to check that the gun is loaded.
A 35 year–old man was admitted to emergency department with a complaint of injury related to the third web space, third finger pulp and thenar region of right hand. On detailed questioning, he reported that he was cleaning a machine gun (type MG-3) after target practice in a shooting range. He didn’t check visually and physically whether there were any bullets or not in the chamber. The remaining bullet in the chamber was fired during the cleaning process when he pushed the rod through the barrel.
All of the wounds were washed with antimicrobial solution. The defect of the third finger pulp was repaired with local flap. Lacerations relevant to the third web space and hypothenar region were sutured and the defect of soft tissue of the thenar region was repaired with skin graft. All of the wounds were healed on postoperative 15th day. If security measures followed explicitly and tightly, will ensure firearms’ safety and reduce accidents. In the case presented here we aimed attention to a rare injury caused by unusual ignition of a bullet during gun-cleaning. There is no reported injury presenting similar mechanism of ours’.

Full text

Accepted Manuscript
Title: Unusual ignition of a bullet causing hand injury: Case
report
Author: Abdul Kerim Yapici Salim Kemal Tuncer Umit
Kaldirim Ibrahim Arziman Mehmet Toygar
PII: S1572-3461(13)00024-X
DOI: http://dx.doi.org/doi:10.1016/j.injury.2013.11.015
Reference: INEXT 818
To appear in: Injury Extra
Received date: 28-9-2013
Revised date: 8-11-2013
Accepted date: 10-11-2013
Please cite this article as: Yapici AK, Tuncer SK, Kaldirim U, Arziman I, Toygar M,
Unusual ignition of a bullet causing hand injury: case report, Injury Extra (2013),
http://dx.doi.org/10.1016/j.injury.2013.11.015
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Unusual ignition of a bullet causing hand injury: case report
Abdul Kerim Yapici M.D. (*)
Salim Kemal Tuncer M.D. (**)
Umit Kaldirim M.D. (**)
Ibrahim Arziman M.D. (**)
Mehmet Toygar M.D. (***)
* Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy,
Ankara / Turkey
** Department of Emergency Medicine, Gulhane Military Medical Academy, Ankara / Turkey
*** Department of Forensic Medicine, Gulhane Military Medical Academy, Ankara / Turkey
Corresponding Author:
Abdul Kerim Yapici, M.D.
Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy,
Ankara/Turkey
Phone: +90 312 304 5408
Fax: +90 312 304 5404
E-mail: dryapici@hotmail.com

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Abstract
Gun-cleaning accidents occur rarely. Gun-cleaning mistakes can cause accidents and even
fatalities. The most dangerous type of gun-cleaning mistake is forgetting to check that the gun
is loaded.
A 35 year–old man was admitted to emergency department with a complaint of injury related
to the third web space, third finger pulp and thenar region of right hand. On detailed
questioning, he reported that he was cleaning a machine gun (type MG-3) after target practice
in a shooting range. He didn’t check visually and physically whether there were any bullets or
not in the chamber. The remaining bullet in the chamber was fired during the cleaning
process when he pushed the rod through the barrel.
All of the wounds were washed with antimicrobial solution. The defect of the third finger
pulp was repaired with local flap. Lacerations relevant to the third web space and hypothenar
region were sutured and the defect of soft tissue of the thenar region was repaired with skin
graft. All of the wounds were healed on postoperative 15th day. If security measures followed
explicitly and tightly, will ensure firearms’ safety and reduce accidents. In the case presented
here we aimed attention to a rare injury caused by unusual ignition of a bullet during gun-
cleaning. There is no reported injury presenting similar mechanism of ours’.
Key words:
Firearm, gun-cleaning accident, hand injury

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Introduction
The incidence of firearm related non-fatal and fatal accidents has increased worldwide (1-5).
Most of firearm accidents result often due to human errors included extreme carelessness
while handling, carrying or storing a loaded firearm (3). Most of the unintentional or
intentional nonfatal gunshot injuries involve an extremity (6). Most gunshot injuries to the
hand are result of low-velocity handguns (7). While low-energy firearm injuries are caused by
small caliber hand guns, BB (ball bearing) guns and zip guns, high energy firearm injuries are
caused by high caliber handguns or assault rifles (8).
Gun-cleaning accidents occur rarely. All firearms are being cleaned periodically and gun-
cleaning mistakes can cause accidents and even fatalities (5). The most dangerous type of
gun-cleaning mistake is forgetting to check whether it is loaded or not, before attempting to
clean the gun (9). The MG3 is a German general-purpose machine gun and is a short recoil-
operated, belt-fed, heavy-barreled, air-cooled machine gun suitable for bursts and sustained
fire. The weapon and its derivatives have also been acquired by the armed forces of over 30
countries (10). We report a case with gunshot wound to the hand caused by ignition of a bullet
while the cleaning a MG3 barrel with gun cleaning rod. In this study, the circumstances
accompanying these injuries, and preventive measures are discussed. These injuries are
preventable, and therefore, some basic measures may reduce the incidence of accidental
injury during gun cleaning procedure.
Case report
A 35 year–old man was admitted to emergency department with a complaint of injury related
to the third web space, third finger pulp and thenar region of right hand. On detailed
questioning, he reported that he was cleaning a machine gun (type MG-3) after target practice

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in a shooting range. He didn’t check visually and physically whether there were any bullets or
not in the chamber. The remaining bullet in the chamber was ignited during the cleaning
process when he pushed the rod through the barrel (Figure 1).
In the physical examination, on his right hand, there were 1.5x1.5 cm full thickness skin
defect on pulp of the third finger accompanying bone exposition on ground, 3x2.5 cm full
thickness skin defect on thenar region, 1 cm depth laceration on third web space from volar to
dorsal and multiple superficial lacerations on volar region (Figure 2). All digits were well
perfused. Neurological findings and motor functions of all digits were within normal range.
There was no fracture on X-ray. All of the wounds were washed with antimicrobial solution
(11). Lacerations relevant to the third web space, hypothenar region and the other multiple
small lacerations of the hand were sutured and the defect of soft tissue of the thenar region
was covered with full thickness skin graft prepared from the severed skin of pulp (Figure 3).
Cast immobilization was applied and intravenous prophylactic antibiotic was administered
postoperatively. All of the wounds were healed on postoperative 15th day and he proceeded
to physiotherapy program after the sutures removed. Patient were seen in outpatient clinic in
every month for 12 months. To prevent development of hypertrophic scar, pomade including
silicone (Dermatix® Silicone Gel) was prescribed (12-13). At the end of the follow-up period
we not encountered any hypertrophic scar development in both primer sutured and grafted
areas. Active and passive range of motion for all fingers was fully achived followed by
physiotherapy program (Figure 4). Patient had fully satisfied with good functionality of his
dominant hand in his daily life and job activity.

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Discussion
All firearms, undergoing mechanical abrasion in the course of time, must be maintained
periodically. Improperly maintained or unmaintained firearms become increasingly less
reliable (9). Firearm cleaning is paramount to ensure safety, accuracy, and longer firearm life.
Guns used for hunting should be cleaned before and after each season. Guns for other uses
such as target shooting or defense should be cleaned routinely to ensure they are ready when
needed. The cleaning rod is used to wipe, scrub and lubricate the bore and each function
requires a special end, attached to the rod. Cleaning rod must be in appropriate length for
cleaned weapon (14).
Safety is an issue that should concern all firearms holders. Accidents occurred during regular
maintenance are so-called “Gun-cleaning accident”. Gun-cleaning accident originated from
the personal negligence rather than a technical defect (5). The first rule for cleaning a firearm
is to ensure that it is definitely unloaded. It is checked that there is no ammunition in the
chamber or in the magazine. As in our case, he didn’t check the machine gun before cleaning
and then the remaining bullet in the chamber was ignited when he pushed the cleaning rod
through the barrel.
When a weapon is fired, the firing pin strikes the center of the primer cup, compressing the
primer composition between the cup and anvil and causing the composition to explode. The
vents in the anvil allow the flame to pass through the flash hole(s) into the cartridge case and
thereby igniting the propellant (15). It did not shoot when trigger was pulled but the
remaining bullet in the chamber was ignited when it was pushed by the rod through the barrel.
After being ignited, bullet pushed the cleaning rod too fast and the rod caused his hand to be
injured. There is no direct contact with bullet. To our best knowledge, there is no reported
injury presenting similar mechanism of ours’.

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Gunshot injuries to the hand can be classified according to the energy of the missile, the
location of the injury, and the tissue types injured (8). These classification patterns are helpful
for determining proper treatment modalities of gunshot injuries to the hand. However, each
injury must be evaluated on an individual basis. As the weapon is a machine gun, it is
normally more likely to cause a high energy injury even resulting in death. The case presented
here is an exception as he is injured only by the cleaning rod but not the bullet itself. But all
persons who are taking care of firearms should be aware of this problem as the different barrel
angle could be fatal for the cleaning person.
Low-velocity gunshot wounds usually involve only the skin, subcutaneous and/or muscle
tissue, and minor cortical bone fragments (7). Although most low-velocity gunshot wounds to
the hand can be closed primarily under some conditions, this is not recommended in high–
velocity injuries because of involving multiple tissue types such as skin, muscle, bone and
joint, and nerve (6). High velocity gunshot wounds require immediate irrigation, removal of
foreign bodies, skeletal stabilization, intravenous antibiotics, serial debridement, and
secondary wound closure within 5 to 7 days after injury followed by timely postoperative
rehabilitation. Low-velocity gunshot wounds are usually treated with local wound care
consisting of superficial irrigation and careful cleansing, cast immobilization, a short course
of oral or intravenous antibiotics, and close follow-up (7). In our case, there was no fracture
on X-ray. Soft tissue defects on the hand were repaired with local flap, skin graft and primary
suturation and cast immobilization was applied in resting position.
Gunshot injuries occurred during cleaning and maintenance procedure is rare but may be
fatal. Injuries to the limbs may cause disability. Unplanned discharge of a firearm is caused by
a failure to observe basic safety rules. To avoid such unexpected and undesirable events,
obeying basic safety rules before cleaning and maintenance procedure is mandatory.
Verifying the gun is unloaded is a must before beginning the cleaning session. Visual and

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physical inspection of the chamber, receiver, and magazine must be performed to ensure that
they are free of ammunition. Pointing the gun in a safe direction and dry firing it is an
additional safety measure. Removing all ammunition from the work area and taking nothing
for granted should be provided (14). If security measures followed explicitly and tightly, will
ensure firearms safety and reduce accidents.

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10. http://en.wikipedia.org/wiki/Rheinmetall_MG3#External_links (Accessed date:
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Figure Legends
Figure 1
Gunshot wound to the hand caused by ignition of a bullet while pushing gun cleaning rod
during cleaning a MG3 barrel with rod
Figure 2
The wounded hand on admission
Figure 3
Postoperative image of the hand
Figure 4
All the wounds were healed at follow-up

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Figure 1

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Figure 2

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Figure 3

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Figure 4