Composition and toxicity of damaging fragments in gunshot and mine-blast spine injuries

The feasibility of removing damaging fragments from the spine in gunshot and mine-blast injuries is assessed based on the data of their composition and cytotoxicity. Four damaging fragments removed from the spine and paravertebral tissues were analyzed. Elemental analysis was performed using a scanning electron microscope. The composition of the damaging fragments was studied using spectral analysis. The cytotoxicity of the medium with damaging fragments was evaluated using the methyl tetrazolium test, comparing to the control medium. Morphological changes in cells were assessed using optical light microscopy, comparing to the control. Elemental analysis showed that all studied fragments consisted of alloys of various metals and other chemical elements. During the first few weeks of incubation in a complete nutrient medium, metals underwent fairly active oxidation, producing an orange precipitate. During further incubation, the oxidation of metals continued quite intensively, leading to a change in the nutrient medium and reducing cell proliferation. Moreover, morphological examination showed that cells exposed to metal oxides were rounded, while control sample cells were elongated and spindle-shaped. The methyl tetrazolium test revealed high cytotoxicity of all the fragments studied. All fragments were found to release toxic metal oxides into the nutrient medium, significantly reducing cell viability, regardless of their elemental composition. To prevent complications associated with possible local and/or systemic toxicity of metal fragments, as well as early and late infections, it is recommended to remove projectiles to the maximum extent feasible.