Cureus. 2018 Apr 13;10(4):e2473. doi: 10.7759/cureus.2473.

Shereen R, Oskouian RJ, Loukas M, Tubbs RS.

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Abstract

The arrow is one of the oldest weapons invented that has ties back to ancient civilization. With the advancement of modern weaponry, literature concerning the management of this traumatic wound has dwindled.  However, there are older written accounts that have led to our understanding of how we manage injuries inflicted by the arrow. One of the more comprehensive accounts was produced in the 19th century by a United States (US) Lieutenant Colonel named JH Bill. Recent cases in forensic pathology, as well as instances of trauma concerning arrowhead injuries, have documented a lack of comprehensive literature for the management of such injuries. Thus, the goal of our review is to evaluate the literature and provide a record of the different presentations, complications, and ways to manage arrow injuries.

KEYWORDS:

arrowhead; management; penetrating injury; trauma

Figure 1

Extraction of non-impacted arrowheads

Figure copied from: Bill JH: Sabre and bayonet wounds; arrow wounds. International Encyclopedia of Surgery: A Systematic Treatise on the Theory and Practice of Surgery By Authors of Various Nations. Ashhurst J (ed): William Wood & Co, New York; 1882. 2:101-117

Figure 2

For arrowheads embedded in bone

Figure copied from: Bill JH: Sabre and bayonet wounds; arrow wounds. International Encyclopedia of Surgery: A Systematic Treatise on the Theory and Practice of Surgery By Authors of Various Nations. Ashhurst J (ed): William Wood & Co, New York; 1882. 2:101-117

Figure 3

Bill's extraction tool for arrowheads impacted in bone

Figure copied from: Bill JH: Sabre and bayonet wounds; arrow wounds. International Encyclopedia of Surgery: A Systematic Treatise on the Theory and Practice of Surgery By Authors of Various Nations. Ashhurst J (ed): William Wood & Co, New York; 1882. 2:101-117

Figure 4

Crocodile forceps for fragmented arrowheads

Figure copied from: Bill JH: Sabre and bayonet wounds; arrow wounds. International Encyclopedia of Surgery: A Systematic Treatise on the Theory and Practice of Surgery By Authors of Various Nations. Ashhurst J (ed): William Wood & Co, New York; 1882. 2:101-117

Figure 5

Arrow impacting the superciliary ridge (left). On the right are images of an arrowhead impacted in rib cages of a buffalo.

Figure copied from: Bill JH: Sabre and bayonet wounds; arrow wounds. International Encyclopedia of Surgery: A Systematic Treatise on the Theory and Practice of Surgery By Authors of Various Nations. Ashhurst J (ed): William Wood & Co, New York; 1882. 2:101-117

Figure 6

Arrowhead lodged in the zygomatic arch.

Figure copied from: Bill JH: Sabre and bayonet wounds; arrow wounds. International Encyclopedia of Surgery: A Systematic Treatise on the Theory and Practice of Surgery By Authors of Various Nations. Ashhurst J (ed): William Wood & Co, New York; 1882. 2:101-117