Distal phalanx of the hand’s digit as unusual autologous biological tissue acting as a contaminating foreign body in a combat patient with ballistic pelvic injury: a case report from war in Ukraine

The use of various types of weapons against the Armed Forces of Ukraine in the Russo-Ukrainian war leads to both typical and atypical clinical presentations of ballistic injuries. Pelvic injuries are common and can result in severe consequences if patient evacuation is delayed. Wounded projectiles are often metal fragments, while biological tissues are rarely found. The aim of this report is to demonstrate the example of the management of the combat patient with ballistic injury to the pelvis associated with contamination by an autologous biologic part of phalanx of the hand’s digit of the wounded. A 36-year-old male service member of the Armed Forces of Ukraine sustained injuries from a shelling incident involving the deployment of a precision-guided munition (KAB) from an aircraft in Eastern Ukraine. The patient was evacuated to the Role 3 deployed field hospital in Kharkiv. A whole-body CT scan revealed two foreign fragments in the abdomen and retroperitoneal space. Damage control surgery was performed. During the operation, the right psoas major muscle was isolated, and a 50 × 30 mm metallic fragment was found and removed. Additionally, while examining the wound tract in the right inguinal region, the distal phalanx of the patient’s right third hand digit was identified and removed. Ballistic injuries in the Russo-Ukrainian war are associated with severe wounds and possible unexpected clinical findings, such as contamination by an autologous biological fragment converted into a projectile. Fast evacuation of the injured person to the appropriate Role of the deployed field facility is associated with good treatment outcomes. Whole-body computed tomography is an important diagnostic tool for evaluating body damage and identifying hidden injuries and fragments of ballistic projectiles. Biological tissue material is an unusual and infrequent foreign body object in the case of ballistic trauma.