{"id":11872,"date":"2025-02-06T22:05:17","date_gmt":"2025-02-06T22:05:17","guid":{"rendered":"https:\/\/langs.physio-pedia.com\/introduction-to-gunshot-injury-rehabilitation-fr\/"},"modified":"2025-02-09T19:57:04","modified_gmt":"2025-02-09T19:57:04","slug":"introduction-to-gunshot-injury-rehabilitation-fr","status":"publish","type":"page","link":"https:\/\/langs.physio-pedia.com\/fr\/introduction-to-gunshot-injury-rehabilitation-fr\/","title":{"rendered":"Introduction \u00e0 la r\u00e9adaptation des personnes bless\u00e9es par arme \u00e0 feu"},"content":{"rendered":"<div class=\"mw-parser-output\">\n<div class=\"editorbox\">\n<p><b>R\u00e9dacteur original<\/b> &#8211; <a class=\"new\" title=\"User:Zafer Altunbezel (page does not exist)\" href=\"\/index.php?title=User:Zafer_Altunbezel&amp;action=edit&amp;redlink=1\">Zafer Altunbezel<\/a><\/p>\n<p><b>Collaboratrices principales<\/b> &#8211; <a class=\"mw-userlink\" title=\"User:Ewa Jaraczewska\" href=\"\/User:Ewa_Jaraczewska\"><bdi>Ewa Jaraczewska <\/bdi><\/a>, <a class=\"mw-userlink\" title=\"User:Jess Bell\" href=\"\/User:Jess_Bell\"><bdi>Jess Bell<\/bdi><\/a> et <a class=\"mw-userlink\" title=\"User:Kim Jackson\" href=\"\/User:Kim_Jackson\"><bdi>Kim Jackson<\/bdi><\/a><\/p>\n<\/div>\n<div id=\"toc\" class=\"toc\" role=\"navigation\" aria-labelledby=\"mw-toc-heading\"><input id=\"toctogglecheckbox\" class=\"toctogglecheckbox\" style=\"display: none;\" role=\"button\" type=\"checkbox\"><\/p>\n<div class=\"toctitle\" dir=\"ltr\" lang=\"en\">\n<h2 id=\"mw-toc-heading\">Contenu<\/h2>\n<\/div>\n<ul>\n<li class=\"toclevel-1 tocsection-1\"><a href=\"#Introduction\"><span class=\"tocnumber\">1<\/span> <span class=\"toctext\">Introduction<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-2\"><a href=\"#Definition_of_Gunshot_Injury\"><span class=\"tocnumber\">2<\/span> <span class=\"toctext\">D\u00e9finition de \u00ab blessure par arme \u00e0 feu \u00bb <\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-3\"><a href=\"#Epidemiology\"><span class=\"tocnumber\">3<\/span> <span class=\"toctext\">\u00c9pid\u00e9miologie<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-4\"><a href=\"#Types_of_Firearms_and_Severity_of_Gunshot_Injury\"><span class=\"tocnumber\">4<\/span> <span class=\"toctext\">Types d&rsquo;armes \u00e0 feu et gravit\u00e9 des blessures par arme \u00e0 feu<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-5\"><a href=\"#Classification\"><span class=\"tocnumber\">4.1<\/span> <span class=\"toctext\">Classification<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-6\"><a href=\"#Low-Velocity_Firearms\"><span class=\"tocnumber\">4.2<\/span> <span class=\"toctext\">Armes \u00e0 feu \u00e0 faible v\u00e9locit\u00e9<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-7\"><a href=\"#Medium-Velocity_Firearms\"><span class=\"tocnumber\">4.3<\/span> <span class=\"toctext\">Armes \u00e0 feu de moyenne v\u00e9locit\u00e9<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-8\"><a href=\"#High-Velocity_Firearms\"><span class=\"tocnumber\">4.4<\/span> <span class=\"toctext\">Armes \u00e0 feu \u00e0 haute v\u00e9locit\u00e9<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-9\"><a href=\"#Mechanism_of_Gunshot_Injuries\"><span class=\"tocnumber\">5<\/span> <span class=\"toctext\">M\u00e9canisme des blessures par arme \u00e0 feu<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-10\"><a href=\"#Effects_of_Gunshot_Injuries\"><span class=\"tocnumber\">6<\/span> <span class=\"toctext\">Cons\u00e9quences des blessures par arme \u00e0 feu<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-11\"><a href=\"#Soft-tissue_Injury\"><span class=\"tocnumber\">6.1<\/span> <span class=\"toctext\">L\u00e9sions des tissus mous<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-12\"><a href=\"#Muscle_Injury\"><span class=\"tocnumber\">6.2<\/span> <span class=\"toctext\">L\u00e9sion musculaire<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-13\"><a href=\"#Nerve_Injury\"><span class=\"tocnumber\">6.3<\/span> <span class=\"toctext\">L\u00e9sion nerveuse<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-14\"><a href=\"#Vascular_Injury_\/_Haemorrhage\"><span class=\"tocnumber\">6.4<\/span> <span class=\"toctext\">L\u00e9sion vasculaire\/h\u00e9morragie<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-15\"><a href=\"#Bone_Injury\"><span class=\"tocnumber\">6.5<\/span> <span class=\"toctext\">L\u00e9sion osseuse<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-16\"><a href=\"#Pain\"><span class=\"tocnumber\">6.6<\/span> <span class=\"toctext\">Douleur<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-17\"><a href=\"#Determinants_of_Injury_Severity\"><span class=\"tocnumber\">7<\/span> <span class=\"toctext\">D\u00e9terminants de la gravit\u00e9 des blessures<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-18\"><a href=\"#Potential_Challenges_and_Secondary_Complications_of_Gunshot_Injuries\"><span class=\"tocnumber\">8<\/span> <span class=\"toctext\">D\u00e9fis potentiels et complications secondaires des blessures par arme \u00e0 feu<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-19\"><a href=\"#Skills_and_Knowledge_Required_to_Treat_Gunshot_Injuries\"><span class=\"tocnumber\">9<\/span> <span class=\"toctext\">Comp\u00e9tences et connaissances requises pour le traitement des blessures par arme \u00e0 feu<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-20\"><a href=\"#Resources\"><span class=\"tocnumber\">10<\/span> <span class=\"toctext\">Ressources<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-21\"><a href=\"#References\"><span class=\"tocnumber\">11<\/span> <span class=\"toctext\">R\u00e9f\u00e9rences<\/span><\/a><\/li>\n<\/ul>\n<\/div>\n<h2><span id=\"Introduction\" class=\"mw-headline\">Introduction<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Introduction\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=1\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Introduction\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=1\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Les blessures par arme \u00e0 feu sont l&rsquo;un des types de blessures les plus courants dans les situations de conflit, les civils devenant de plus en plus vuln\u00e9rables dans les conflits arm\u00e9s du 21e si\u00e8cle. Les blessures par arme \u00e0 feu sont des blessures \u00e0 haute \u00e9nergie qui peuvent provoquer des l\u00e9sions tissulaires importantes, la paralysie ou la mort. L&rsquo;\u00e9tendue de la blessure d\u00e9pend d&rsquo;un certain nombre de facteurs. Les professionnels de la r\u00e9adaptation doivent comprendre les cons\u00e9quences potentielles et les strat\u00e9gies de prise en charge appropri\u00e9es \u00e0 chaque phase de la r\u00e9adaptation afin d&rsquo;am\u00e9liorer les r\u00e9sultats des patients.<\/p>\n<h2><span id=\"Definition_of_Gunshot_Injury\" class=\"mw-headline\">D\u00e9finition de \u00ab blessure par arme \u00e0 feu \u00bb <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Definition of Gunshot Injury\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=2\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Definition of Gunshot Injury\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=2\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<blockquote><p>Une blessure par arme \u00e0 feu est une \u00ab\u00a0blessure p\u00e9n\u00e9trante et ses cons\u00e9quences associ\u00e9es caus\u00e9es par un projectile provenant d&rsquo;une arme \u00e0 feu\u00a0\u00bb<sup id=\"cite_ref-:2_1-0\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1).<\/a><\/sup><\/p><\/blockquote>\n<h2><span id=\"Epidemiology\" class=\"mw-headline\">\u00c9pid\u00e9miologie<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Epidemiology\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=3\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Epidemiology\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=3\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>L&rsquo;\u00e9pid\u00e9miologie des blessures par arme \u00e0 feu est difficile \u00e0 \u00e9valuer et varie en fonction de la population, le contexte du conflit, du pays, des caract\u00e9ristiques du conflit et du moment o\u00f9 il s&rsquo;est produit<sup id=\"cite_ref-:2_1-1\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1)<\/a><\/sup> :<\/p>\n<ul>\n<li>Wild et al. ont cherch\u00e9 \u00e0 d\u00e9crire \u00ab les blessures li\u00e9es aux conflits subies par les civils et les combattants locaux dans les conflits du 21e si\u00e8cle \u00bb<sup id=\"cite_ref-:4_2-0\" class=\"reference\"><a href=\"#cite_note-:4-2\">(2)<\/a><\/sup>. Ils ont constat\u00e9 que <sup id=\"cite_ref-:4_2-1\" class=\"reference\"><a href=\"#cite_note-:4-2\">(2)<\/a><\/sup> :\n<ul>\n<li>les blessures par balle ont caus\u00e9 22% des blessures chez les civils et les combattants locaux;<\/li>\n<li>les blessures par arme \u00e0 feu sont le deuxi\u00e8me m\u00e9canisme de blessure le plus fr\u00e9quent chez le personnel militaire am\u00e9ricain dans les conflits arm\u00e9s, causant 19,9 % des blessures.<\/li>\n<\/ul>\n<\/li>\n<li>Wild et al.<sup id=\"cite_ref-:4_2-2\" class=\"reference\"><a href=\"#cite_note-:4-2\">(2)<\/a><\/sup> ont \u00e9galement constat\u00e9 que les milieux urbains et semi-urbains pr\u00e9sentent des taux plus \u00e9lev\u00e9s de blessures par arme \u00e0 feu :\n<ul>\n<li>les blessures par arme \u00e0 feu constituaient 42,2 % des blessures en milieu urbain;<\/li>\n<li>les blessures par arme \u00e0 feu constituaient 26,7 % des blessures en milieu semi-urbain;<\/li>\n<li>les blessures par arme \u00e0 feu constituaient 7,5 % des blessures en milieu rural.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>En 2020, aux \u00c9tats-Unis, plus de 45 000 d\u00e9c\u00e8s ont \u00e9t\u00e9 attribu\u00e9s \u00e0 des blessures caus\u00e9es par une arme \u00e0 feu<sup id=\"cite_ref-:3_3-0\" class=\"reference\"><a href=\"#cite_note-:3-3\">(3)<\/a><\/sup> (soit 13,6 pour 100 000 personnes<sup id=\"cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\">(4)<\/a><\/sup>).<\/li>\n<\/ul>\n<h2><span id=\"Types_of_Firearms_and_Severity_of_Gunshot_Injury\" class=\"mw-headline\">Types d&rsquo;armes \u00e0 feu et gravit\u00e9 des blessures par arme \u00e0 feu <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Types of Firearms and Severity of Gunshot Injury\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=4\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Types of Firearms and Severity of Gunshot Injury\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=4\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Le potentiel de blessure d&rsquo;une arme \u00e0 feu d\u00e9pend de plusieurs facteurs, dont :<\/p>\n<ul>\n<li>le type d&rsquo;arme \u00e0 feu (vitesse initiale);<\/li>\n<li>le type de balle;<\/li>\n<li>la distance par rapport \u00e0 la cible;<\/li>\n<li>la taille des plombs.<\/li>\n<\/ul>\n<p>En fonction de la vitesse initiale, les armes \u00e0 feu peuvent \u00eatre divis\u00e9es en armes \u00e0 faible v\u00e9locit\u00e9, \u00e0 v\u00e9locit\u00e9 moyenne ou \u00e0 haute v\u00e9locit\u00e9.<sup id=\"cite_ref-:2_1-2\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1)<\/a><\/sup><\/p>\n<h3><span id=\"Classification\" class=\"mw-headline\">Classification<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Classification\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=5\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Classification\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=5\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Les blessures par arme \u00e0 feu peuvent \u00eatre class\u00e9es en fonction du type d&rsquo;arme \u00e0 feu et de la classification des fractures ouvertes de Gustilo-Anderson. Pour en savoir plus sur ce syst\u00e8me de classification, cliquer ici : <a class=\"external text\" href=\"https:\/\/www.orthobullets.com\/trauma\/1003\/gustilo-classification\" rel=\"nofollow\">\u00ab\u00a0Gustilo Classification\u00a0\u00bb<\/a>.<\/p>\n<h3><span id=\"Low-Velocity_Firearms\" class=\"mw-headline\">Armes \u00e0 feu \u00e0 faible v\u00e9locit\u00e9 <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Low-Velocity Firearms\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=6\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Low-Velocity Firearms\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=6\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Les armes \u00e0 feu \u00e0 faible v\u00e9locit\u00e9, y compris les armes de poing et les pistolets, ont une vitesse initiale inf\u00e9rieure \u00e0 350 m\/s<sup id=\"cite_ref-:2_1-3\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1)<\/a><\/sup>. Elles provoquent g\u00e9n\u00e9ralememt des blessures de type I et de type II de la classification de Gustilo-Anderson<sup id=\"cite_ref-:1_5-0\" class=\"reference\"><a href=\"#cite_note-:1-5\">(5)<\/a><\/sup>.<\/p>\n<ul>\n<li>Type I<sup id=\"cite_ref-:1_5-1\" class=\"reference\"><a href=\"#cite_note-:1-5\">(5)<\/a><\/sup><sup id=\"cite_ref-:11_6-0\" class=\"reference\"><a href=\"#cite_note-:11-6\">(6)<\/a><\/sup> :\n<ul>\n<li>faible \u00e9nergie;<\/li>\n<li>taille de la plaie inf\u00e9rieure \u00e0 un centim\u00e8tre;<\/li>\n<li>l\u00e9sions minimes des tissus mous et comminution de la fracture;<\/li>\n<li>plaie propre;<\/li>\n<li>aucune l\u00e9sion neuromusculaire.<\/li>\n<\/ul>\n<\/li>\n<li>Type II<sup id=\"cite_ref-:1_5-2\" class=\"reference\"><a href=\"#cite_note-:1-5\">(5)<\/a><\/sup><sup id=\"cite_ref-:11_6-1\" class=\"reference\"><a href=\"#cite_note-:11-6\">(6)<\/a><\/sup> :\n<ul>\n<li>\u00e9nergie mod\u00e9r\u00e9e;<\/li>\n<li>taille de la plaie entre 1 et 10 centim\u00e8tres;<\/li>\n<li>l\u00e9sions mod\u00e9r\u00e9es des tissus mous et comminution de la fracture;<\/li>\n<li>contamination mod\u00e9r\u00e9e de la plaie;<\/li>\n<li>aucune l\u00e9sion neuromusculaire.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3><span id=\"Medium-Velocity_Firearms\" class=\"mw-headline\">Armes \u00e0 feu de moyenne v\u00e9locit\u00e9 <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Medium-Velocity Firearms\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=7\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Medium-Velocity Firearms\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=7\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Les armes \u00e0 feu \u00e0 v\u00e9locit\u00e9 moyenne, y compris les armes de poing de gros calibre et les fusils de chasse, ont une vitesse de bouche comprise entre 350 et 600 m\/s<sup id=\"cite_ref-:2_1-4\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1)<\/a><\/sup> . Cependant, la gravit\u00e9 de la blessure d\u00e9pend de plusieurs facteurs, notamment de la distance et du projectile<sup id=\"cite_ref-:2_1-5\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1)<\/a><\/sup><sup id=\"cite_ref-:5_7-0\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup> .<\/p>\n<p>Exemple : les fusils de chasse sont des armes \u00e0 feu de v\u00e9locit\u00e9 moyenne, mais en raison de la \u00ab masse totale importante de leurs plombs, leur \u00e9nergie cin\u00e9tique peut \u00eatre fortement augment\u00e9e. (&#8230;) En fonction de la distance par rapport \u00e0 la cible et de la taille des plombs, les fusils de chasse peuvent avoir le potentiel de blessure d&rsquo;armes \u00e0 feu \u00e0 haute v\u00e9locit\u00e9 ou de plusieurs armes \u00e0 basse v\u00e9locit\u00e9. (&#8230;) Une tr\u00e8s grande proximit\u00e9 entre le fusil et la cible (&lt; 2 m) entra\u00eene non seulement la projection des plombs, mais aussi de fragments de la douille et de la bourre<sup id=\"cite_ref-:10_8-0\" class=\"reference\"><a href=\"#cite_note-:10-8\">(8)<\/a><\/sup>.\u00bb<\/p>\n<h3><span id=\"High-Velocity_Firearms\" class=\"mw-headline\">Armes \u00e0 feu \u00e0 haute v\u00e9locit\u00e9 <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: High-Velocity Firearms\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=8\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: High-Velocity Firearms\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=8\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Les armes \u00e0 feu \u00e0 haute v\u00e9locit\u00e9, y compris les fusils militaires et de chasse, ont une vitesse initiale sup\u00e9rieure \u00e0 600 m\/s<sup id=\"cite_ref-:2_1-6\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1)<\/a><\/sup> , et elles sont associ\u00e9es \u00e0 des l\u00e9sions tissulaires plus importantes<sup id=\"cite_ref-:5_7-1\" class=\"reference\"><a href=\"#cite_note-:5-7\">(7)<\/a><\/sup> . Elles provoquent g\u00e9n\u00e9ralement des blessures de type III de la classification de Gustilo-Anderson de Gustilo-Anderson<sup id=\"cite_ref-:1_5-3\" class=\"reference\"><a href=\"#cite_note-:1-5\">(5)<\/a><\/sup> .<\/p>\n<ul>\n<li>Type III (A, B ou C)<sup id=\"cite_ref-:1_5-4\" class=\"reference\"><a href=\"#cite_note-:1-5\">(5)<\/a><\/sup><sup id=\"cite_ref-:11_6-2\" class=\"reference\"><a href=\"#cite_note-:11-6\">(6)<\/a><\/sup> :\n<ul>\n<li>haute \u00e9nergie;<\/li>\n<li>taille de la plaie g\u00e9n\u00e9ralement sup\u00e9rieure \u00e0 10 centim\u00e8tres;<\/li>\n<li>l\u00e9sions \u00e9tendues des tissus mous;<\/li>\n<li>fracture s\u00e9v\u00e8rement comminutive;<\/li>\n<li>contamination \u00e9tendue de la plaie;<\/li>\n<li>pr\u00e9sence d&rsquo;un d\u00e9p\u00e9riostage;<\/li>\n<li>lambeau de couverture peut \u00eatre n\u00e9cessaire (III B et III C);<\/li>\n<li>pr\u00e9sence possible d&rsquo;une fracture ouverte avec des l\u00e9sions art\u00e9rielles n\u00e9cessitant une r\u00e9paration (III C).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 402px;\"><a class=\"image\" href=\"\/File:Gunshot_Injury_Mechanism.png\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/f\/fa\/Gunshot_Injury_Mechanism.png\/400px-Gunshot_Injury_Mechanism.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/f\/fa\/Gunshot_Injury_Mechanism.png\/600px-Gunshot_Injury_Mechanism.png 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/f\/fa\/Gunshot_Injury_Mechanism.png\/800px-Gunshot_Injury_Mechanism.png 2x\" alt=\"\" width=\"400\" height=\"154\" data-file-width=\"1748\" data-file-height=\"674\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p><small>Figure 1. M\u00e9canisme de la blessure par arme \u00e0 feu.<\/small><\/p>\n<\/div>\n<\/div>\n<\/div>\n<h2><span id=\"Mechanism_of_Gunshot_Injuries\" class=\"mw-headline\">M\u00e9canisme des blessures par arme \u00e0 feu <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Mechanism of Gunshot Injuries\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=9\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Mechanism of Gunshot Injuries\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=9\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<ul>\n<li>Le projectile frappe le corps et transf\u00e8re son \u00e9nergie cin\u00e9tique et sa chaleur aux tissus.<\/li>\n<li>Cela cr\u00e9e un orifice de p\u00e9n\u00e9tration permanent dont la taille correspond approximativement \u00e0 la section transversale du projectile.<\/li>\n<li>En raison de l&rsquo;\u00e9nergie cin\u00e9tique \u00e9lev\u00e9e du projectile, une pression extr\u00eame se produit momentan\u00e9ment autour de l&rsquo;orifice de p\u00e9n\u00e9tration.<\/li>\n<li>Cette pression extr\u00eame provoque un \u00e9tirement momentan\u00e9 du tissu autour de la trajectoire du projectile, formant une cavit\u00e9 temporaire, avant de se contracter \u00e0 nouveau.<\/li>\n<li>Le projectile peut sortir du corps (cr\u00e9ant g\u00e9n\u00e9ralement un orifice de sortie plus gros), rester dans le corps ou changer de direction.<\/li>\n<li>Parfois, le projectile se fragmente ou explose dans le corps, causant d&rsquo;autres dommages<sup id=\"cite_ref-:2_1-7\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1)<\/a><\/sup> .<\/li>\n<\/ul>\n<h2><span id=\"Effects_of_Gunshot_Injuries\" class=\"mw-headline\">Cons\u00e9quences des blessures par arme \u00e0 feu <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Effects of Gunshot Injuries\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=10\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Effects of Gunshot Injuries\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=10\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<blockquote><p>\u00ab Alors que les tissus de l&rsquo;orifice de p\u00e9n\u00e9tration subissent des l\u00e9sions directes dues au transfert d&rsquo;\u00e9nergie, les tissus environnants de la cavit\u00e9 temporaire subissent des l\u00e9sions secondaires dues aux br\u00fblures et \u00e0 l&rsquo;\u00e9tirement extr\u00eame<sup id=\"cite_ref-:2_1-8\" class=\"reference\"><a href=\"#cite_note-:2-1\">(2)<\/a><\/sup>.\u00bb<\/p><\/blockquote>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Gunshot_Injury_Cross-Section.001.jpeg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/d\/d7\/Gunshot_Injury_Cross-Section.001.jpeg\/300px-Gunshot_Injury_Cross-Section.001.jpeg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/d\/d7\/Gunshot_Injury_Cross-Section.001.jpeg\/450px-Gunshot_Injury_Cross-Section.001.jpeg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/d\/d7\/Gunshot_Injury_Cross-Section.001.jpeg\/600px-Gunshot_Injury_Cross-Section.001.jpeg 2x\" alt=\"\" width=\"300\" height=\"225\" data-file-width=\"1024\" data-file-height=\"768\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p><small>Figure 2. Coupe transversale d&rsquo;une blessure par balle.<\/small><\/p>\n<\/div>\n<\/div>\n<\/div>\n<p>Les blessures par arme \u00e0 feu peuvent avoir toute une panoplie de cons\u00e9quences, notamment des l\u00e9sions diffuses des tissus mous, des l\u00e9sions musculaires, des l\u00e9sions nerveuses, des l\u00e9sions vasculaires\/h\u00e9morragies, des l\u00e9sions osseuses et des douleurs intenses<sup id=\"cite_ref-:0_9-0\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup> . Ces blessures sont abord\u00e9es plus en d\u00e9tail ci-dessous.<\/p>\n<h4><span id=\"Soft-tissue_Injury\" class=\"mw-headline\">L\u00e9sions des tissus mous <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Soft-tissue Injury\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=11\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Soft-tissue Injury\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=11\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>L&rsquo;orifice permanent ainsi que la cavit\u00e9 temporaire provoquent des l\u00e9sions des tissus mous<sup id=\"cite_ref-:0_9-1\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup> :<\/p>\n<ul>\n<li>les tissus de la cavit\u00e9 primaire (permanente) sont bless\u00e9s par le projectile et le transfert d&rsquo;\u00e9nergie cin\u00e9tique extr\u00eame; <sup id=\"cite_ref-:2_1-9\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1)<\/a><\/sup><\/li>\n<li>les tissus de la cavit\u00e9 temporaire sont \u00ab d\u00e9truits par la compression et le cisaillement du projectile qui laisse une marque<sup id=\"cite_ref-:0_9-2\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup> \u00bb.<\/li>\n<\/ul>\n<p>Les tissus mous peuvent \u00eatre partiellement ou totalement l\u00e9s\u00e9s, notamment par des ruptures, des lac\u00e9rations, des br\u00fblures internes et des cicatrices aux stades ult\u00e9rieurs.<sup id=\"cite_ref-:2_1-10\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1)<\/a><\/sup><\/p>\n<h4><span id=\"Muscle_Injury\" class=\"mw-headline\">L\u00e9sion musculaire <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Muscle Injury\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=12\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Muscle Injury\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=12\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<blockquote><p>\u00ab\u00a0Le muscle squelettique est plus susceptible d&rsquo;\u00eatre endommag\u00e9 par l&rsquo;office permanent, la cavit\u00e9 temporaire induisant moins de dommages (\u00e0 moins que le syst\u00e8me vasculaire ne soit atteint) en raison de l&rsquo;\u00e9lasticit\u00e9 inh\u00e9rente du muscle squelettique\u00a0\u00bb<sup id=\"cite_ref-:0_9-3\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup>.<\/p><\/blockquote>\n<p>Les muscles squelettiques peuvent \u00eatre affect\u00e9s par une lac\u00e9ration, une contusion ou un \u00e9crasement, une d\u00e9nervation, une h\u00e9morragie, une isch\u00e9mie, des br\u00fblures et une perte musculaire volum\u00e9trique. Les traumatismes primaires peuvent \u00eatre compliqu\u00e9s par des traumatismes secondaires, dont<sup id=\"cite_ref-:0_9-4\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup> :<\/p>\n<ul>\n<li>infection et septic\u00e9mie dues \u00e0 la contamination par la balle ou aux d\u00e9bris accumul\u00e9s sur les v\u00eatements ou la peau;<\/li>\n<li>d\u00e9bridement chirurgical des tissus endommag\u00e9s;<\/li>\n<li>mouvements physiques excessifs.<\/li>\n<\/ul>\n<p>L&rsquo;immobilisation et la carence nutritionnelle peuvent entra\u00eener une perte musculaire volum\u00e9trique apr\u00e8s une blessure par arme \u00e0 feu.<\/p>\n<h4><span id=\"Nerve_Injury\" class=\"mw-headline\">L\u00e9sion nerveuse <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Nerve Injury\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=13\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Nerve Injury\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=13\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Les blessures par balle peuvent causer : <sup id=\"cite_ref-:6_10-0\" class=\"reference\"><a href=\"#cite_note-:6-10\">(10)<\/a><\/sup><\/p>\n<ul>\n<li>une section directe de nerfs;<\/li>\n<li>des l\u00e9sions indirectes dues aux dommages thermiques, aux ondes de choc et aux lac\u00e9rations caus\u00e9es par le d\u00e9placement des fragments de la fracture;<\/li>\n<li>une comppression due \u00e0 un \u0153d\u00e8me ou \u00e0 une cicatrisation subaigu\u00eb.<\/li>\n<\/ul>\n<p>Par cons\u00e9quent, les blessures par arme \u00e0 feu peuvent entra\u00eener une axonotm\u00e8se, une neuropraxie et une neurotm\u00e9sis.<sup id=\"cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\">(11)<\/a><\/sup> <b>L&rsquo;axonotm\u00e8se<\/b> \u00ab\u00a0d\u00e9crit les diverses l\u00e9sions des nerfs p\u00e9riph\u00e9riques qui sont plus graves qu&rsquo;une atteinte mineure, comme celles qui entra\u00eenent une neurapraxie, mais moins graves que la section du nerf, telle qu&rsquo;elle est observ\u00e9e dans la neurotm\u00e8se\u00a0\u00bb.<sup id=\"cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\">(12)<\/a><\/sup> <b>La neuropraxie<\/b> est la \u00ab d\u00e9my\u00e9linisation segmentaire focale au site de la blessure, sans rupture de la continuit\u00e9 de l&rsquo;axone et des tissus conjonctifs environnants \u00bb.<sup id=\"cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\">(13)<\/a><\/sup> <b>La neurotm\u00e9sis<\/b> est une \u00ab section compl\u00e8te d&rsquo;un nerf p\u00e9riph\u00e9rique \u00bb.<sup id=\"cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\">(14)<\/a><\/sup><\/p>\n<p>Les nerfs les plus fr\u00e9quemment touch\u00e9s dans les membres sup\u00e9rieurs sont le nerf ulnaire et le plexus brachial<sup id=\"cite_ref-:6_10-1\" class=\"reference\"><a href=\"#cite_note-:6-10\">(10)<\/a><\/sup>. Sheilds et al. notent \u00e9galement que, dans les cas de blessures par arme \u00e0 feu, \u00ab\u00a0les l\u00e9sions vasculaires et les fractures augmentent le risque de l\u00e9sions nerveuses\u00a0\u00bb<sup id=\"cite_ref-:6_10-2\" class=\"reference\"><a href=\"#cite_note-:6-10\">(10)<\/a><\/sup>.<\/p>\n<h4><span id=\"Vascular_Injury_.2F_Haemorrhage\"><\/span><span id=\"Vascular_Injury_\/_Haemorrhage\" class=\"mw-headline\">L\u00e9sion vasculaire\/h\u00e9morragie <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Vascular Injury \/ Haemorrhage\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=14\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Vascular Injury \/ Haemorrhage\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=14\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Les vaisseaux sanguins peuvent \u00eatre bless\u00e9s directement ou affect\u00e9s par un trouble circulatoire secondaire<sup id=\"cite_ref-:2_1-11\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1)<\/a><\/sup>. Une l\u00e9sion vasculaire peut entra\u00eener une perte de sang ou une h\u00e9morragie (interne ou externe). Une zone h\u00e9morragique peut se former autour des tissus irr\u00e9versiblement endommag\u00e9s \u00e0 la suite d&rsquo;une blessure par arme \u00e0 feu. Cette zone d&rsquo;extravasation \u00ab se caract\u00e9rise par un saignement interstitiel en l&rsquo;absence de destruction tissulaire macroscopiquement \u00e9vidente \u00bb<sup id=\"cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\">(15)<\/a><\/sup>.<\/p>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Highly-comminuted-fracture-gun-shot-injury.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/1\/1c\/Highly-comminuted-fracture-gun-shot-injury.jpg\/300px-Highly-comminuted-fracture-gun-shot-injury.jpg\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/1\/1c\/Highly-comminuted-fracture-gun-shot-injury.jpg\/450px-Highly-comminuted-fracture-gun-shot-injury.jpg 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/1\/1c\/Highly-comminuted-fracture-gun-shot-injury.jpg\/600px-Highly-comminuted-fracture-gun-shot-injury.jpg 2x\" alt=\"\" width=\"300\" height=\"370\" data-file-width=\"1635\" data-file-height=\"2018\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p><small>Figure 3. <a class=\"external text\" href=\"https:\/\/radiopaedia.org\/cases\/46134\/studies\/50489\" rel=\"nofollow\">Fracture tr\u00e8s comminutive &#8211; blessure par arme \u00e0 feu<\/a>. Avec l&rsquo;aimable autorisation de Dr Matt Skalski, ; rID:46134<\/small><\/p>\n<\/div>\n<\/div>\n<\/div>\n<h4><span id=\"Bone_Injury\" class=\"mw-headline\">L\u00e9sion osseuse <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Bone Injury\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=15\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Bone Injury\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=15\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Les blessures par arme \u00e0 feu entra\u00eenent g\u00e9n\u00e9ralement des <b>fractures comminutives et d\u00e9plac\u00e9es<\/b><sup id=\"cite_ref-:2_1-12\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1)<\/a><\/sup>:<\/p>\n<ul>\n<li>caus\u00e9e par une p\u00e9n\u00e9tration balistique \u00e0 haute \u00e9nergie;<\/li>\n<li>un effet secondaire de la cavitation associ\u00e9 aux propri\u00e9t\u00e9s fluides de la moelle osseuse;<\/li>\n<li>associ\u00e9e \u00e0 une incidence \u00e9lev\u00e9e de complications secondaires, y compris l&rsquo;infection et la pseudarthrose<sup id=\"cite_ref-:9_16-0\" class=\"reference\"><a href=\"#cite_note-:9-16\">(16)<\/a><\/sup> :\n<ul>\n<li>le taux d&rsquo;infection est plus \u00e9lev\u00e9 chez les patients ayant un lambeau cutan\u00e9e<sup id=\"cite_ref-:9_16-1\" class=\"reference\"><a href=\"#cite_note-:9-16\">(16)<\/a><\/sup> ,<\/li>\n<li>le taux de pseudarthrose est plus \u00e9lev\u00e9 chez les patients pr\u00e9sentant des l\u00e9sions vasculaires<sup id=\"cite_ref-:9_16-2\" class=\"reference\"><a href=\"#cite_note-:9-16\">(16)<\/a><\/sup> .<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Un <b>\u00ab effet de trou de forage \u00bb<\/b> est souvent caus\u00e9 par des blessures \u00e0 faible \u00e9nergie dans un os poreux de faible densit\u00e9 ou un os spongieux<sup id=\"cite_ref-:10_8-1\" class=\"reference\"><a href=\"#cite_note-:10-8\">(8)<\/a><\/sup>:<\/p>\n<ul>\n<li>plus fr\u00e9quent au bassin, au f\u00e9mur distal, \u00e0 l&rsquo;hum\u00e9rus proximal et au rachis<sup id=\"cite_ref-:10_8-2\" class=\"reference\"><a href=\"#cite_note-:10-8\">(8)<\/a><\/sup>;<\/li>\n<li>p\u00e9n\u00e9tration balistique \u00e0 faible \u00e9nergie;<\/li>\n<li>affecte la r\u00e9gion m\u00e9taphysaire des os longs.<\/li>\n<\/ul>\n<p>Fractures unicorticales :<\/p>\n<ul>\n<li>peuvent \u00eatre dues \u00e0 un \u00ab impact de projectile \u00e0 faible \u00e9nergie qui ne provoque qu&rsquo;une l\u00e9sion osseuse tangentiel \u00bb<sup id=\"cite_ref-:10_8-3\" class=\"reference\"><a href=\"#cite_note-:10-8\">(8)<\/a><\/sup>.<\/li>\n<\/ul>\n<p>Fractures transversales ou spiral\u00e9es :<\/p>\n<ul>\n<li>peuvent \u00eatre caus\u00e9es par des tirs \u00e0 faible \u00e9nergie sur des os corticaux diaphysaires denses et hautement min\u00e9ralis\u00e9s.<\/li>\n<\/ul>\n<p>Les blessures par arme \u00e0 feu peuvent entra\u00eener des traumatismes secondaires (par exemple, une chute), qui peuvent \u00e9galement entra\u00eener une fracture<sup id=\"cite_ref-:10_8-4\" class=\"reference\"><a href=\"#cite_note-:10-8\">(8)<\/a><\/sup><sup id=\"cite_ref-17\" class=\"reference\"><a href=\"#cite_note-17\">(17)<\/a><\/sup>.<\/p>\n<h4><span id=\"Pain\" class=\"mw-headline\">Douleur<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Pain\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=16\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Pain\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=16\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<ul>\n<li>Les patients ayant subi des blessures par arme \u00e0 feu dans un contexte de combat pr\u00e9sentent un risque \u00e9lev\u00e9 de douleur chronique, \u00ab 45% plus \u00e9lev\u00e9 que dans la population g\u00e9n\u00e9rale chez les traumatis\u00e9s civils \u00bb<sup id=\"cite_ref-:8_18-0\" class=\"reference\"><a href=\"#cite_note-:8-18\">(18)<\/a><\/sup>.<\/li>\n<li>70% des personnes bless\u00e9es par balle d\u00e9veloppent des douleurs chroniques<sup id=\"cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\">(19)<\/a><\/sup>.<\/li>\n<li>Kuchyn et Horoshko<sup id=\"cite_ref-:8_18-1\" class=\"reference\"><a href=\"#cite_note-:8-18\">(18)<\/a><\/sup> ont constat\u00e9 que les personnes bless\u00e9es par des armes \u00e0 feu \u00e0 trois endroits ou plus pr\u00e9sentaient un pourcentage plus \u00e9lev\u00e9 de douleurs chroniques que celles qui n&rsquo;avaient \u00e9t\u00e9 bless\u00e9es qu&rsquo;\u00e0 un ou deux endroits.<\/li>\n<li>Le syndrome douloureux r\u00e9gional complexe (SDRC) peut survenir apr\u00e8s des \u00e9v\u00e9nements traumatiques, y compris des blessures par arme \u00e0 feu<sup id=\"cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\">(20)<\/a><\/sup>.<\/li>\n<\/ul>\n<h2><span id=\"Determinants_of_Injury_Severity\" class=\"mw-headline\">D\u00e9terminants de la gravit\u00e9 des blessures <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Determinants of Injury Severity\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=17\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Determinants of Injury Severity\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=17\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<ul>\n<li>Projectile : vitesse, masse, forme, calibre, mat\u00e9riau, lacet et distance d&rsquo;impact<sup id=\"cite_ref-:0_9-5\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup><sup id=\"cite_ref-:2_1-13\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1)<\/a><\/sup> :\n<ul>\n<li>masse et forme : plus le diam\u00e8tre et la longueur du projectile augmentent, plus les dommages risquent d&rsquo;\u00eatre importants;<\/li>\n<li>vitesse : lorsque la vitesse augmente, la quantit\u00e9 d&rsquo;\u00e9nergie cin\u00e9tique s&rsquo;accro\u00eet consid\u00e9rablement, ce qui entra\u00eene des dommages plus importants;<\/li>\n<li>distance d&rsquo;impact : en parcourant de plus grandes distances, les projectiles perdent une plus grande partie de leur \u00e9nergie cin\u00e9tique et causent ainsi moins de dommages, alors que des projectiles m\u00eame plus petits, tir\u00e9s \u00e0 une distance rapproch\u00e9e, peuvent causer des dommages consid\u00e9rables;<\/li>\n<li>le lacet est \u00ab l&rsquo;angle entre le grand axe de la balle et sa direction de vol \u00bb<sup id=\"cite_ref-:7_21-0\" class=\"reference\"><a href=\"#cite_note-:7-21\">(21)<\/a><\/sup>. Au fur et \u00e0 mesure que la distance augmente, le projectile perd sa stabilit\u00e9 et commence \u00e0 d\u00e9vier. Bien que cela diminue la quantit\u00e9 d&rsquo;\u00e9nergie cin\u00e9tique transf\u00e9r\u00e9e, cela peut augmenter la surface de la section transversale, causant ainsi plus de dommages.<sup id=\"cite_ref-:2_1-14\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1)<\/a><\/sup><\/li>\n<\/ul>\n<\/li>\n<li>Type de tissu : densit\u00e9, \u00e9lasticit\u00e9 et \u00e9paisseur<sup id=\"cite_ref-:0_9-6\" class=\"reference\"><a href=\"#cite_note-:0-9\">(9)<\/a><\/sup> :\n<ul>\n<li>une grande \u00e9lasticit\u00e9 et une faible densit\u00e9 entra\u00eenent moins de l\u00e9sions<sup id=\"cite_ref-:7_21-1\" class=\"reference\"><a href=\"#cite_note-:7-21\">(21)<\/a><\/sup>;<\/li>\n<li>la peau est tr\u00e8s \u00e9lastique et sa densit\u00e9 est relativement faible;<\/li>\n<li>les poumons ont une densit\u00e9 beaucoup plus faible et absorbent moins d&rsquo;\u00e9nergie;<\/li>\n<li>les os sont denses et absorbent plus d&rsquo;\u00e9nergie.<\/li>\n<\/ul>\n<\/li>\n<li>Les points d&rsquo;entr\u00e9e et de sortie et la trajectoire \u00e0 l&rsquo;int\u00e9rieur du corps<sup id=\"cite_ref-:2_1-15\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1)<\/a><\/sup> :\n<ul>\n<li>s&rsquo;ils sont situ\u00e9s \u00e0 proximit\u00e9 d&rsquo;un plexus nerveux, les l\u00e9sions peuvent \u00eatre plus graves;<\/li>\n<li>s&rsquo;ils sont proches des art\u00e8res ou des veines majeures, la pr\u00e9sentation clinique peut \u00eatre plus compliqu\u00e9e.<\/li>\n<\/ul>\n<\/li>\n<li>Fragmentation des projectiles :\n<ul>\n<li>plus de fragments = plus d&rsquo;une trajectoire dans le corps, ce qui entra\u00eene des probl\u00e8mes internes plus graves \u00e0 traiter dans les jours et les mois suivants<sup id=\"cite_ref-:2_1-16\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1)<\/a><\/sup>.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h2><span id=\"Potential_Challenges_and_Secondary_Complications_of_Gunshot_Injuries\" class=\"mw-headline\">D\u00e9fis potentiels et complications secondaires des blessures par arme \u00e0 feu <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Potential Challenges and Secondary Complications of Gunshot Injuries\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=18\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Potential Challenges and Secondary Complications of Gunshot Injuries\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=18\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>La prise en charge des complications secondaires li\u00e9es aux blessures par arme \u00e0 feu est complexe. Une intervention pr\u00e9coce et des connaissances approfondies sont n\u00e9cessaires pour optimiser les r\u00e9sultats de la r\u00e9adaptation.<\/p>\n<p>Certaines complications secondaires des blessures par arme \u00e0 feu sont \u00e9num\u00e9r\u00e9es ci-dessous<sup id=\"cite_ref-:2_1-17\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1)<\/a><\/sup> :<\/p>\n<ul>\n<li><strong><a title=\"Contractures\" href=\"\/Contractures\">des contractures articulaires<\/a><\/strong> peuvent se d\u00e9velopper \u00e0 la suite de p\u00e9riodes d&rsquo;immobilisation apr\u00e8s des fractures ouvertes comminutives et complexes qui n\u00e9cessitent des fixations externes ou internes;<\/li>\n<li>des <strong><a title=\"Neuropathic Pain\" href=\"\/Neuropathic_Pain\">douleurs <\/a><a title=\"Myofascial Pain\" href=\"\/Myofascial_Pain\">myofasciales<\/a>, <a title=\"Chronic Pain\" href=\"\/Chronic_Pain\">chroniques<\/a> ou neuropathiques<\/strong> peuvent appara\u00eetre en raison de cicatrices internes, de br\u00fblures internes, d&rsquo;une infection de plaies ou d&rsquo;os;<\/li>\n<li>les <strong>l\u00e9sions des nerfs p\u00e9riph\u00e9riques<\/strong> qui ne sont pas d\u00e9tect\u00e9es au d\u00e9part en raison de l&rsquo;h\u00e9t\u00e9rog\u00e9n\u00e9it\u00e9 et des conditions sur le terrain peuvent n\u00e9cessiter l&rsquo;orientation vers un sp\u00e9cialiste;<\/li>\n<li><strong>une <a title=\"Deep Vein Thrombosis\" href=\"\/Deep_Vein_Thrombosis\">thrombose veineuse profonde<\/a> ou diff\u00e9rents types d&#8217;embolie;<\/strong><\/li>\n<li>le <strong><a title=\"Complex Regional Pain Syndrome (CRPS)\" href=\"\/Complex_Regional_Pain_Syndrome_(CRPS)\">syndrome douloureux r\u00e9gional complexe<\/a> (causalgie)<\/strong>, connu sous le nom de \u00ab\u00a0military pain syndrome\u00a0\u00bb en anglais- \u00ab affecte g\u00e9n\u00e9ralement les soldats de combat apr\u00e8s avoir \u00e9t\u00e9 bless\u00e9s par des explosions et des tirs pendant la guerre \u00bb<sup id=\"cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\">(22)<\/a><\/sup>;<\/li>\n<li><strong><a title=\"Central Sensitisation\" href=\"\/Central_Sensitisation\">une sensibilisation centrale;<\/a><\/strong><\/li>\n<li>des <a title=\"Mental Health Issues and Rehabilitation\" href=\"\/Mental_Health_Issues_and_Rehabilitation\"><strong>probl\u00e8mes de sant\u00e9 mentale<\/strong><\/a>, y compris le <strong>trouble de stress post traumatique, l&rsquo;anxi\u00e9t\u00e9 ou la <a title=\"D\u00e9pression\" href=\"\/Depression\">d\u00e9pression<\/a><\/strong>, qui ont tendance \u00e0 s&rsquo;aggraver avec le temps, avec une d\u00e9gradation \u00e0 long terme de l&rsquo;\u00e9tat de sant\u00e9 mentale<sup id=\"cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\">(23)<\/a><\/sup>.<\/li>\n<\/ul>\n<h2><span id=\"Skills_and_Knowledge_Required_to_Treat_Gunshot_Injuries\" class=\"mw-headline\">Comp\u00e9tences et connaissances requises pour le traitement des blessures par arme \u00e0 feu <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Skills and Knowledge Required to Treat Gunshot Injuries\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=19\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Skills and Knowledge Required to Treat Gunshot Injuries\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=19\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Il est recommand\u00e9 aux professionnels de la r\u00e9adaptation qui traitent les personnes victimes de blessures par arme \u00e0 feu d&rsquo;avoir une bonne compr\u00e9hension des sujets suivants<sup id=\"cite_ref-:2_1-18\" class=\"reference\"><a href=\"#cite_note-:2-1\">(1)<\/a><\/sup> :<\/p>\n<ul>\n<li>la neuroanatomie :\n<ul>\n<li>proc\u00e9der \u00e0 un examen neurologique,<\/li>\n<li>planifier le traitement,<\/li>\n<li>reconna\u00eetre les signes et les sympt\u00f4mes qui justifient une orientation vers des services sp\u00e9cialis\u00e9s;<\/li>\n<\/ul>\n<\/li>\n<li>la neuroscience de la douleur :\n<ul>\n<li>donner des informations au patient sur la douleur afin de l&rsquo;aider \u00e0 g\u00e9rer sa douleur chronique ou persistante;<\/li>\n<\/ul>\n<\/li>\n<li>le raisonnement clinique :\n<ul>\n<li>pour la prise en charge de cas complexes,<\/li>\n<li>collaborer avec une \u00e9quipe pluridisciplinaire ou la diriger;<\/li>\n<\/ul>\n<\/li>\n<li>les comp\u00e9tences manuelles :\n<ul>\n<li>pour aider \u00e0 traiter les contractures articulaires, les cicatrices internes et les atteintes neurog\u00e8nes.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h2><span id=\"Resources\" class=\"mw-headline\">Ressources<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Resources\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=20\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Resources\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=20\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<ul>\n<li><a class=\"external text\" href=\"https:\/\/www.orthobullets.com\/Site\/ElasticSearch\/StandardSearchTiles?contentType=6&amp;search=Gun%20Shot%20Wounds\" rel=\"nofollow\">Gun Shot Wounds (site internet d&rsquo;Orthobullets sur les blessures par arme \u00e0 feu)<\/a><\/li>\n<\/ul>\n<h2><span id=\"References\" class=\"mw-headline\">R\u00e9f\u00e9rences<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: References\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;veaction=edit&amp;section=21\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: References\" href=\"\/index.php?title=Introduction_to_Gunshot_Injury_Rehabilitation&amp;action=edit&amp;section=21\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<div class=\"mw-references-wrap mw-references-columns\">\n<ol class=\"references\">\n<li id=\"cite_note-:2-1\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:2_1-0\">1.00<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-1\">1.01<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-2\">1.02<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-3\">1.03<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-4\">1.04<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-5\">1.05<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-6\">1.06<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-7\">1.07<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-8\">1.08<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-9\">1.09<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-10\">1.10<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-11\">1.11<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-12\">1.12<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-13\">1.13<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-14\">1.14<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-15\">1.15<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-16\">1.16<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-17\">1.17<\/a><\/sup> <sup><a href=\"#cite_ref-:2_1-18\">1.18<\/a><\/sup><\/span> <span class=\"reference-text\">Altunbezel Z. Introduction to Gunshot Injury Rehabilitation Course. Plus, 2024. <\/span><\/li>\n<li id=\"cite_note-:4-2\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:4_2-0\">2.0<\/a><\/sup> <sup><a href=\"#cite_ref-:4_2-1\">2.1<\/a><\/sup> <sup><a href=\"#cite_ref-:4_2-2\">2.2<\/a><\/sup><\/span> <span class=\"reference-text\">Wild H, Stewart BT, LeBoa C, Stave CD, Wren SM. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7223167\/pdf\/268_2020_Article_5428.pdf\" rel=\"nofollow\">Epidemiology of Injuries Sustained by Civilians and Local Combatants in Contemporary Armed Conflict: An Appeal for a Shared Trauma Registry Among Humanitarian Actors<\/a>. World J Surg. 2020 Jun;44(6):1863-1873.<\/span><\/li>\n<li id=\"cite_note-:3-3\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-:3_3-0\">\u2191<\/a><\/span> <span class=\"reference-text\">Stewart S, Tunstall C, Stevenson T. Gunshot wounds in civilian practice: a review of epidemiology, pathophysiology and management. Orthopaedics and Trauma 2023; 37(4):216-221.<\/span><\/li>\n<li id=\"cite_note-4\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-4\">\u2191<\/a><\/span> <span class=\"reference-text\">Menezes JM, Batra K, Zhitny VP. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC10445625\/\" rel=\"nofollow\">A nationwide analysis of gunshot wounds of the head and neck: morbidity, mortality, and cost<\/a>. J Craniofac Surg. 2023 Sep 1;34(6):1655-60. <\/span><\/li>\n<li id=\"cite_note-:1-5\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:1_5-0\">5.0<\/a><\/sup> <sup><a href=\"#cite_ref-:1_5-1\">5.1<\/a><\/sup> <sup><a href=\"#cite_ref-:1_5-2\">5.2<\/a><\/sup> <sup><a href=\"#cite_ref-:1_5-3\">5.3<\/a><\/sup> <sup><a href=\"#cite_ref-:1_5-4\">5.4<\/a><\/sup><\/span> <span class=\"reference-text\">Gustilo Classification. Available from <a class=\"external free\" href=\"https:\/\/www.orthobullets.com\/trauma\/1003\/gustilo-classification\" rel=\"nofollow\">https:\/\/www.orthobullets.com\/trauma\/1003\/gustilo-classification<\/a> (last access 14.04.2024)<\/span><\/li>\n<li id=\"cite_note-:11-6\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:11_6-0\">6.0<\/a><\/sup> <sup><a href=\"#cite_ref-:11_6-1\">6.1<\/a><\/sup> <sup><a href=\"#cite_ref-:11_6-2\">6.2<\/a><\/sup><\/span> <span class=\"reference-text\">Kim PH, Leopold SS. <a class=\"external text\" href=\"https:\/\/journals.lww.com\/clinorthop\/fulltext\/2012\/11000\/gustilo_anderson_classification.48.aspx\" rel=\"nofollow\">In brief: Gustilo-Anderson classification<\/a>. (corrected). Clin Orthop Relat Res. 2012 Nov;470(11):3270-4. doi: 10.1007\/s11999-012-2376-6. Epub 2012 May 9. Erratum in: Clin Orthop Relat Res. 2012 Dec;470(12):3624. Erratum in: Clin Orthop Relat Res. 2019 Oct;477(10):2388. <\/span><\/li>\n<li id=\"cite_note-:5-7\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:5_7-0\">7.0<\/a><\/sup> <sup><a href=\"#cite_ref-:5_7-1\">7.1<\/a><\/sup><\/span> <span class=\"reference-text\">Baum GR, Baum JT, Hayward D, MacKay BJ. <a class=\"external text\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC9462949\/pdf\/orr-14-293.pdf\" rel=\"nofollow\">Gunshot Wounds: Ballistics, Pathology, and Treatment Recommendations, with a Focus on Retained Bullets.<\/a> Orthop Res Rev. 2022 Sep 5;14:293-317.<\/span> <\/li>\n<li id=\"cite_note-:10-8\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:10_8-0\">8.0<\/a><\/sup> <sup><a href=\"#cite_ref-:10_8-1\">8.1<\/a><\/sup> <sup><a href=\"#cite_ref-:10_8-2\">8.2<\/a><\/sup> <sup><a href=\"#cite_ref-:10_8-3\">8.3<\/a><\/sup> <sup><a href=\"#cite_ref-:10_8-4\">8.4<\/a><\/sup><\/span> <span class=\"reference-text\">Gugala Z, Lindsey RW. <a class=\"external text\" href=\"https:\/\/journals.lww.com\/clinorthop\/fulltext\/2003\/03000\/classification_of_gunshot_injuries_in_civilians.7.aspx\" rel=\"nofollow\">Classification of Gunshot Injuries in Civilians. 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J Trauma. 2002 Oct;53(4):709-16. <\/span><\/li>\n<\/ol>\n<\/div>\n<p><!-- NewPP limit report Cached time: 20240513073018 Cache expiry: 0 Reduced expiry: true Complications: (show\u2010toc) CPU time usage: 0.125 seconds Real time usage: 0.136 seconds Preprocessor visited node count: 566\/1000000 Post\u2010expand include size: 71\/2097152 bytes Template argument size: 0\/2097152 bytes Highest expansion depth: 3\/100 Expensive parser function count: 0\/100 Unstrip recursion depth: 0\/20 Unstrip post\u2010expand size: 17817\/5000000 bytes --><br \/>\n<!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 7.293 1 Special:Contributors\/Introduction_to_Gunshot_Injury_Rehabilitation 100.00% 7.293 1 -total --><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>R\u00e9dacteur original &#8211; Zafer Altunbezel Collaboratrices principales &#8211; Ewa Jaraczewska , Jess Bell et Kim Jackson Contenu 1 Introduction 2 D\u00e9finition de \u00ab blessure par arme \u00e0 feu \u00bb 3 \u00c9pid\u00e9miologie 4 Types d&rsquo;armes \u00e0 feu et gravit\u00e9 des blessures par arme \u00e0 feu 4.1 Classification 4.2 Armes \u00e0 feu \u00e0 faible v\u00e9locit\u00e9 4.3 Armes [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-11872","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/langs.physio-pedia.com\/fr\/wp-json\/wp\/v2\/pages\/11872","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/langs.physio-pedia.com\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/langs.physio-pedia.com\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/langs.physio-pedia.com\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/langs.physio-pedia.com\/fr\/wp-json\/wp\/v2\/comments?post=11872"}],"version-history":[{"count":1,"href":"https:\/\/langs.physio-pedia.com\/fr\/wp-json\/wp\/v2\/pages\/11872\/revisions"}],"predecessor-version":[{"id":11877,"href":"https:\/\/langs.physio-pedia.com\/fr\/wp-json\/wp\/v2\/pages\/11872\/revisions\/11877"}],"wp:attachment":[{"href":"https:\/\/langs.physio-pedia.com\/fr\/wp-json\/wp\/v2\/media?parent=11872"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}