Gunshot Wounds

Sean Asks:

Hi Jordyn!

Looking for a little bit of help with some 9mm gunshot wounds. I was going for non-lethal aside from possible bleeding out and injuries that would have long recovery time.

I have a character get shot at point blank range in the lower right abdomen from the front. Then in the right shoulder/clavicle, also from the front, about five to ten feet away, breaking the clavicle. Finally, in the left calf from behind from ten to fifteen feet away, breaking the tibia which is made worse when the shooter grinds his foot into it.

I’m guessing the shoulder/clavicle and calf/tibia would require a sling or cast and a serious amount of PT. The abdomen wound I’m guessing would require some reconstructive surgery depending on if and how much the bullet bounced around?
I figured it would take her almost a year to walk without assistance from those. Am I close in that assessment? Thanks in advance for ANY help!

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Jordyn Says:

Since this is largely a rehab question I reached out to Tim Bernacki, a great physical therapist, who I highly recommend from personal experience. If you live near Castle Rock, CO look up his clinic, Front Range Therapies.

Tim Says:

Generally, time frame of healing is 6-8 weeks for most things, especially soft tissue. All these injuries would require surgery. The clavicle fracture would require an open reduction/internal fixation (ORIF)—this means that there is an incision made and hardware placed to stabilize the fracture.

I wouldn’t know what is done if the clavicle is “shattered” and is in a multitude of pieces. The wound would have to be a glancing hit that results in a fracture. Anything more severe in the area could result in ruptured arteries, as well, and the person cannot die from this wound.

The tibia fracture also would require an ORIF—either plate, screws, or rod with locking screws. The difficult thing in all this would be that due to the leg recovery, the person will be using an assistive device, but probably cannot use crutches due to the clavicle pain. Perhaps a walker could be used. Depends on how conditioned the person is, how young, etc . . .

The leg injury would require limited weight bearing for 6 weeks I would guess. If all heals as expected according to x-rays, then they would transition into weight bearing as tolerated (WBAT). Probably would have a limp for several weeks after that. Likely wouldn’t run until four months following surgery if all goes well. The clavicle would probably have a sling for maybe 2-4 weeks (if no repairs to muscle or rotator cuff were done). After that, overhead reach would be most affected and for several months.

As for the abdominal injury, other than not bearing down with pressure for a short time, I wouldn’t think there are other issues to consider.

I’ve seen some gunshot wounds (GSW) where the bullet enters, hits a long bone, changes course and travels along the bone. This assumes the round is a practice round (full metal jacket) and not a hollow point. Hollow point bullets or defensive rounds open up when they hit something, resulting in a much-enlarged object/wound. I’ve seen rounds left in place because taking them out was unnecessary and I’ve seen rounds removed because of the location. Sometimes there are exit wounds and sometimes there aren’t depending on what stops the round. Sounds like there wouldn’t be an exit wound with the clavicle and leg but could be with the abdominal (perhaps in the low back).

Hope this helps and good luck with your story!

Dale Asks:

I see in TV shows and movies people who are shot or stabbed go to get medical treatment and yet they never deal with the police. Or they refuse to go because they are afraid that it will get reported. If a person is taken to the ER with a knife wound or gunshot wound, would the medical staff have to report it to the police?

Jordyn Says:

Police car lights close up. A group of policemen on the background.

Yes, we have to notify the police if a person is shot or stabbed with nefarious intent. Knives can cause lots of wounds that aren’t criminally motivated. Think about the person slicing vegetables and cuts their finger. Knife wound . . . not criminally motivated. We wouldn’t call the police.

The most important aspect is whether or not the person is being truthful regarding their injury. It’s obvious if someone comes in with a gunshot wound that something criminal has likely happened.

If a person comes in with a knife stuck in their chest, we’re likely getting the police involved even if they say it was an “accident”. However, say a woman comes in with a defensive knife wound to the palm of her hand as she tried to keep her boyfriend from stabbing her, but she tells us that she cut it grabbing a knife from the bottom of a sink full of soapy water. If the woman doesn’t have any other suspicious injuries, we probably wouldn’t question her story.

In all honesty, we can only help patients as much as they are willing to help themselves. If they are truthful about the violence involved in whatever type of injury they have (particularly beatings from domestic abuse) then there is help we can offer them.

Ever wonder why you’re asked when presenting for medical care whether or not you feel safe? This is inherently because we know, as healthcare providers, that it is hard for victims to speak up. That question is your open door. If you feel you can’t answer honestly at the time, then look for a way to speak to your nurse or physician privately. Sometimes we try and facilitate a conversation like this by asking other visitors to step out of the room. If we do this, it should signal to you that we are suspicious that your injury did not happen the way you stated and we’re trying to find a way to help you.

It is true a patient might not seek medical treatment for fear of police involvement. The same can be true for child abuse injuries. A parent may not seek treatment or delay treatment for fear of being reported to child protective services and/or the police.

See how the different variables can vary to increase conflict in your story?