Ballistic fractures - the limited value of existing classifications

We have assessed a number of ballistic fracture classifications but were unable to identify one that could adequately grade the severity of the injury, assist in determining the optimal treatment or predict outcome. Many of the existing classifications are based on experimental studies or radiological appearance and do not take into account the soft tissue injury, which is usually the main prognostic indicator. In addition few differentiated between different bones, and some were specific to only one bone. We would suggest that ballistic fractures are treated on an individual basis, specifically considering the soft tissue injury, the anatomical location of the injury and any involvement of joints. The specific weapon or muzzle velocity are not of prime importance, and classifications should not be based on these.