Atypical gunshot injuries: A review of case reports and case series

Background and aim: Gunshot injuries are important public health concerns that contribute significantly to disability and mortality, but atypical cases remain underexplored. This review synthesizes the published literature to identify factors that experts/authors use to classify gunshot injuries as atypical, intending to deepen insights and improve forensic interpretations and clinical outcomes. Methods: Following a scoping review framework, we searched PubMed using keywords related to the terms “atypical,” “gunshot,” and “case report.” We included peer-reviewed case reports and case series in English with no date restrictions. We excluded reviews, typical injury studies, animal studies, and non-English publications. Data were extracted into an Excel spreadsheet to identify patterns in injury characteristics and forensic/clinical implications. Results: From the 390 records identified, 237 records spanning 1977–2024 were analyzed after screening. Cases were predominantly concentrated in North America and Europe. The classifications of atypical entities fall into four main categories or themes: unusual anatomical locations, aberrant wound patterns, unconventional weapons or ammunition, and unanticipated clinical presentations or complications and unique treatment. Conclusions: These findings challenge standard ballistic and clinical assumptions and emphasize the need for enhanced forensic tools and individualized treatment approaches in the management of such patients. This scoping review addresses a critical gap by providing forensic experts with better interpretation frameworks and clinicians with refined care strategies.