Emedinews: Insights on Medicolegal issues - Firearm injuries of the head

In most firearm injuries of the head, the bullet passes completely through the skull. As it enters the skull, the bullet produces a clean cut hole in the outer table and a larger hole in the inner table. At its point of exit, these conditions are reversed and the hole in the outer table is larger than the hole in the inner table. 

• These facts are often of importance in determining the direction of fire in bullet injuries of the head. The track of a bullet through the brain tissues varies greatly, depending on the range and stability of the bullet. 
• On the other hand, if it remains high velocity at the time that it impacts with the skull, there may be considerable damage from the cavitation effect within the skull. Fissured fractures often radiate through the vault and base of the skull from the bullet entrance and exit holes.
• In certain bullet injuries of the head, the bullet may fail to emerge from the skull and in these cases an area of bony comminuting is often found at the site of lodgment. 
• When a bullet strikes the head at a tangent, penetration of the skull may final to occur, but the force of the bullet may be sufficient to fragment the inside table at the site of impact. 

(Contributed by Dr Sudhir Gupta)