Plastic bulletand jawsM. A. COHEN

•• •InjUrIeS of the

SAMT DEEL 68 7 DESEMBER 1985 849

face

Summary

The plastic bullet or plastic baton round was intro­duced as an anti-riot weapon in 1976. It has evolvedfrom the rubber bullet and wooden baton round.During the recent unrest in South Africa the plasticbullet was used in riot control. Five cases of facialinjury are reported. One involved the middle third ofthe face and 4 the lower third. In all cases skinlacerations compounded facial fractures. Mandibularfractures ranged from a single displaced body fractureto severe comminuted fractures. The middle-thirdinjury was sufficiently severe to result in blindness ofone eye.

S At, Med J 1985; 68: 849·852.

The plastic bullet or, more correctly, the plastic baton round,was introduced as a riot-control weapon in Northern Irelandin 1976. It has evolved from the rubber bullet, which was firstused in 1970 during civil unrest in Northern Ireland. This inturn developed from the wooden baton round which was usedas an anti-riot weapon by the police during the Hong Kongriots of the 19S0s and 1960s. 1

The rubber bullet is a missile which is bullet-shaped, IS cmlong, 3,5 cm in diameter and weighs 135 - 140 g. It fits into ametal canister which has a propellant charge of SS grains at itsbase. The muzzle velocity is about 73 m/s and it flies throughthe air with a tumbling motion, having a high wind resistance. 2

Injuries caused by rubber bullets have been documented byMillar er al.,2 who reported 90 cases from Torthern Ireland.Of these, 35 involved facial structures and the skull. Use of therubber bullet was abandoned in Northern Ireland, and it hasbeen replaced by the plastic bullet, which is made of PVC(polyvinyl chloride). It is shorter than the rubber bullet,having a length of about 10 cm and a diameter of 3,7 cm. It isblunt-ended and sealed into a canister with a charge of 45grains in the base' (Fig. 1). The plastic bullet is more accuratein flight and has a longer range than the rubber bullet, thusbeing considered superior as a riot-control weapon. It is firedfrom the same weapon, which is designed to fire canisters ofCS gas, called the Webley-Schermully gun or police riot gunin orthern Ireland.

Since the paper by Miller er al. 2 appeared, several reportsdescribing rubber bullet and plastic baton round injuries ofthe face and jaws have appeared in the literature. I

,)-6 Thepurpose of my article is to present experience of plastic bulletinjuries of the face and jaws which occurred during the civilunrest in South Africa during 1984.

Division of Maxillofacial and Oral Surgery, Department ofSurgery, University of the Witwatersrand, JohannesburgM. A. COHEN, B.sc., B.D.S., M.DENT., F.F.D. (S.A.).

Fig. 1. Plastic baton round with its canister.

Injuries and their management

Five cases of facial injuries caused by rubber bullets weretreated. All patients were black men. In all cases skin lacerationsdue to the impact of the bullet were present. These varied inseverity from linear lacerations to irregular, stellate-shapedwounds. Bruising of the skin around the lacerations was acommon feature (Figs 2 and 3). One patient sustained injuriesto the middle third of the face while in 4 cases they were of thelower third, all with mandibular fractures. Swelling of the faceand neck was usually marked. In I case a severe sublingual

Fig. 2. Mid-facial injury with irregular stellate laceration of theskin. The left eye was enucleated (case 4).

850 SAMJ VOLUME 68 7 DECEMBER 1985

Fig. 3. Laceration of the skin over the right body of the mandible.Bruising due to the impact of the missile is present (case 2).

haematoma was associated with the mandibular fracture (case3). None of the injuries was life-threatening. All were treatedin a routine fashion, with closed or open reduction of thefractures and repair of the skin lacerations. Details of theinjuries and management in each case are shown in Table I.

Discussion

Injuries to the face and jaws caused by plastic bullets are

severe, resulting in soft- and hard-tissue damage. in the singlecase which involved the middle third of the facial skeleton theleft eye was ruptured, resulting in its enucleation. In the seriesof rubber bullet injuries reported by Millar el al.,2 24 patients(27%) sustained injuries to the eye and adnexa. Blindness orsevere loss of vision occurred in 14 of these cases. Orbital andeye injuries due to plastic bullets have also been reported byothers. J

•s In a study which compared the injuries caused by

plastic bullets with those caused by rubber bullets,6 it wasfound that plastic bullets struck the head and chest less oftenthan rubber bullets, resulting in fewer facial fractures. However,skull and brain injuries appeared to be more severe. This wasattributed to the plastic bullet having a greater accuracy andbeing more stable in flight than the rubber bullet.

In this series, injuries to the lower third of the facialskeleton were fairly typical. In all cases the plastic bulletcaused a laceration, which was either linear or star-shaped.The mandible was fractured in all cases. In 2 cases the bonecomminuted at the point of impact, with indirect or contrecoupfractures (Figs 4 - 6). In I case (case 2) the bone fractured oneither side of the point of impact of the missile, while inanother a single fracture of an edentulous mandible occurredover the point of impact.

Mandibular fractures comprised the majority of injuries tothe facial skeleton in this series. Others 1.2 have reported ahigher incidence of middle-third facial fractures from riot­control missiles. Whatever the injury, it is probably too severefor effective riot control using minimum force. 2 An inquiryinto deaths and injuries caused by plastic bullets organized bythe Association for Legal Justice found that these weapons hadbeen misused in Torthem Ireland.7 The police and Armyregulations in orthem Ireland state that these bullets shouldbe used only as a last resort at a range of more than 20 metres,and that they should be fired at the lower parts of the body or

TABLE I. INJURIES CAUSED BY PLASTIC BULLETS AND THEIR MANAGEMENT

Case AgeNo. (yrs) Sex Race Soft-tissue injury Hard-tissue injury Management

69 M Black 8 cm linear laceration extending Fracture of right para- Reduction and immobilizationfrom right cheek to submental symphysis of mandible of fracture with bone plateregion of chin. Paraesthesia of compounded to skin. l\IIoderateright lip displacement of fra.gments

2 26 M Black Stellate-shaped laceration of Fracture of right-angle of Extraction of right mandibularskin over right body of mandible mandible and symphysis. third molar tooth. Direct fixation

Moderate displacement of of right-angle fracture with wirefragments. Angle fracture and intermaxillary fixationcompounded to skin

3 22 M Black 4 cm linear laceration of skin Comminuted fracture of right Debridement of fracture andover right body of mandible and body and symphysis of reduction and immobilizationextending to chin. Severe mandible. Fracture com- with interdental eyelet wiring.swelling of submandibular area pounded to skin lacerationand neck. Severe swelling ofright floor of mouth and sub-lingual haematoma

4 19 M Black Stellate laceration over nasal Fractured nasal bridge and Enucleation of left eye. Delayedbridge extending to cheek. anterior wall of left maxillary suture of skin and repair ofPerforation of left globe of eye sinus nasal fracture

5 23 M Black Linear laceration from right Comminuted fracture of right Debridement of right body ofcheek to lower lip body of mandible. Low mandible. Reduction and immo-

fracture of right condyle and bilization with interdental eyeletcrack fracture of left para- wiringsymphysis

SAMT DEEL 68 7 DESEMBER 1985 851

Fig. 4. Mandibular orthopantograph of the patient shown in Fig. 3. Fractures occurred on either side of the point of impact of themissile (arrowed).

Fig. 5. Postoperative radiograph of patient shown in Figs 3 and 4. Placing of direct osteosynthesis wire to the right body fracturewas carried out through the skin laceration.

at the ground in front of the rioters with the idea that theywould bounce off the ground and hit them on the legs or lowerabdomen, thus deterring stone-throwers but not causing severeinjury. The low death rate associated with the use of plasticbullets gave the soldiers sufficient confidence to fire theweapon at will and not as a last resort. The inquiry found thatof the 14 deaths caused by rubber and plastic bullets, 6 werein children, while injuries sustained by other children weresevere enough to warrant hospitalization. In a letter to theeditor of The Lancer Redgrave8 states: 'US Congressmen havecriticised the use of plastic bullets in Northern Ireland; theEuropean Parliament has called for a ban, as have the Labour,

Liberal and Social Democratic parties. Surely, in the light ofthe serious injuries described, doctors should speak out againstthe continuing use of plastic bullets .. .'.

On the basis of the findings of this report and experiencegained from other parts of the world, it appears that plasticand rubber bullets have failed as riot-control weapons, andthat the serious injuries caused by these weapons warrantdiscontinuation of their use.

I am grateful to Professor I. Smith for his permission to usecase 5 in this report.

852 SAMJ VOLUME 68 7 DECEMBER 1985

Fig. 6. Orthopantograph showing comminuted fracture of the right body of the mandible. Additional fracture lines are present inthe ascending ramus and parasymphyseal areas (arrowed).

REFERENCES

I. Sberedon SM, Wbitlock RIH. Plastic baton round injuries. Br J Oral Surg1983; 21: 259-267.

2. Millar R, Rutberford WH, Jobnston S, Malbofra VJ. Injuries cause<;l b}'rubber bullets: a report on 90 patients. BrJ Surg 1975; 62: 480-486.

3. Pbillips JG. Plastic bullet injury: a case report. Br J Oral Surg 1977; 14:199-202.

4. Wbitlock RIH, Gorman JM. Some missile injuries due to civil unrest inNorthern Ireland. Ine J Oral Surg 1978; 7: 240-245.

5. Wbitlock RI1:I. Experience gained from treating facial injuries due to civilunrest. Ann R Coll Surg Eng11981; 63: 31-44.

6. Rocke L. Injuries caused by plastic bullets compared witb tbose caused byrubber bullets. Lancet 1983; i: 919-920.

7. Redgrave AP. Plastic bullets: tbe medical facts. World Med 1983; 3: 52-55.8. Redgrave AP. Plastic bullets in riot control. Lancet 1983; i: 1224.

Nuus en Kommentaar/News and Comment

Reducing football accidents

Football - not rugby but soccer - is now the most popularsport in many parts of Europe. For example the Swiss Asso­ciation contains no less than 200000 members, and they haverecently been worried about the increasing number of accidents.In consequence the Swiss Bureau for the Prevention of Acci­dents and the Swiss Association of Health Insurers havecombined to launch a campaign entitled 'Entirely SafeFootball'. It seems that no less than 160000 sports accidentscause claims on the insurance companies of Switzerlandannually and cost them something like R250 million. Just overa quarter of this sum is due to football accidents, with aboutthe same level of ski accidents. Aquatic sports account for only7,7% of the total cost. However, while the figure for skiaccidents has been stabilized, the figure for football accidentscontinues to increase.

As a start to the campaign, the two associations have issueda leaflet giving advice about avoidance of accidents. The mostimportant is to play the ball and not the player. Nobodyshould play football without a period of training or begin amatch without warming up. Proper shoes should be worn;individuals should not participate in competitions above theirability. Above all, respecting the principles of fair play woulddo much·to lower the accident rate.

'Abortion here, artificial insemination there'

This is the title of a short report by Godtel (Drsch Aerzrebl1985; 82: 1849) about a conference for psychosomatic obstetricsand gynaecology which was held recently in Col()gne. The twochief themes at this meeting for continuing <;ducation wereunwanted pregnancy and artificial insemination. Last yearWest Germany spent approximately R200 million on 87000interruptions of pregnancy. On the other hand, there were7 733 embryo transfers and I 209 pregnancies recorded, re­sulting in the birth of 562 infants to 517 mothers.

Some German gynaecologists are beginning to worry aboutthis uncritical belief in progress in the area of reproduction.Will this concern to produce only babies of high quality leadus in the 21st century to the production of the superman andsuperwoman? If so, who will benefit? It has been shown thatscience very rapidly acquires its own dynamics and cannotthen be checked, a chastening thought for would-be improversof the human race.

However, as Professor Staubers of Berlin pointed out, it isnot the task of the doctor to improve mankind. In his opinion,a more responsible attitude, in particular towards artificialinsemination and in vilro fertilization, is needed to counteractthe possible abuse of medical power.