Amongst modern warfare injuries, the majority are explosive fragment injuries. At the same time, because of differences in their exposed area and anatomical position, injury incidence rates for different parts of the body are also different.

Amongst war injuries, craniocerebral wounds have a high rate of incidence. In the Iraq and Afghanistan Wars, there were 1255 cases of brain injuries, of which 774 involved fragment penetration and 481 blunt trauma. An analysis of 10 years of recent American army injuries demonstrates that the majority of early deaths before arrival at military hospital are the result of craniocerebral wounds. Amongst injuries affecting different parts of the body, craniocerebral wounds account for 42.3 % of injuries causing immediate or early death (Table 3).

Maxillofacial fragment injury is a common injury in the firearm wound class. According to reports [4], head and facial injuries accounted for 13 % of injuries in the Soviet-Afghan war and 19 % of injuries in the Chechen conflict. During 1991s Operation Desert Storm, 17.3 % of injuries sustained by the US military were head and face injuries and 4.3 % neck injuries. Israeli war statistics demonstrate that 24 % of its military injuries were head and face injuries and 12 % neck injuries. From July 1998 to March 1999, during US military operations in Mogadishu, Somalia, head and facial wounds accounted for 36 % of all injuries.

Because of the increased use of explosive weaponry in modern warfare, eye wounds have also increased in incidence (Table 4). Artillery shell fragments and blast shockwaves can cause eye and adnexal lesions, with more than 70 % of eye injuries caused by penetration from explosive fragments. These injuries often result in the loss or damage of the eye and treatment is very difficult.

With regards to colorectal war wounds, data demonstrates 35 % of these were caused by explosive fragmentation, 5 % by vehicle accidents, 1 % by falls and 1 % by blunt trauma (Table 5).

In wars from the last decade, the two main causes of injury, accounting for nearly 75 % of wounds, have been penetrative explosive fragmentation injuries and penetrative gunshot wounds. During this period the survival rate from such wounds reached an historical record of 90 %. During the Vietnam War the survival rate from penetrative injuries was 84 % and in World War 2 80 %.

In the period from October 2001 to June 2011, 4596 cases of war injury deaths were retrospectively analyzed and in 73.7 % of cases the cause of death was identified as explosive fragmentation injury, in 21.1 % of cases the cause was gunshot wounds and in 4.2 % of cases the cause was other injuries including vehicle accident injuries. 87.3 % of deaths occurred before arriving at the medical treatment facility (MTF), of which 35.2 % (1619 cases) were instant deaths and 52.1 % (2397 cases) were deaths occurring several minutes to several hours subsequent to the incident but prior to MTF arrival. Only in 12.7 % of cases (580) did death occur after arriving at the medical treatment facility (Fig. 3). In addition, amongst fatal wounds, the injury severity score (ISS) was recorded as between 25–50 points in 61.2 % of cases (Fig. 4).

The main cause of fatal injury from fragmentation is explosive weaponry, namely the fragmentation warhead or shell. The fragmentation warhead is one of the main types of warheads, detonating high explosives to release a large quantity of high-speed fragments to destroy targets by way of such fragments’ impact, and incendiary and explosive effects. These can be used to fatally injure biological creatures (humans, animals) and damage unarmored or light-armored vehicles, aircraft, radars, missiles and other armored equipment. According to their means of generating fragments , fragmentation warheads can be divided into three types: natural, controlled and pre-fragmentation. The grenade shell is a typical example of the pre-fragmentation type.

Natural fragmentation is caused by the shell expanding and breaking after detonation. Such shells are characterized by the casing not only acting as a container, but for the way the container itself also degrades into potentially deadly fragments. Such fragments are of an uneven, irregular shape but typically decelerate quickly in flight and have a limited range in causing fatal injury.

Controlled fragmentation employs a housing groove or lining for the explosive materials, or uses some other technical measures to partially weaken the shell and control its breaking points thereby producing fragments. Such warheads are characterized by broken pieces of uniform size and shape.

Pre-fragmentation warheads are molded to house a predetermined design and quantity of steel balls, steel arrowheads, tungsten balls, tungsten pellets or similar materials that can be fitted either on the inside or outside surface of the warhead or shell. These pre-made fragments and the natural fragments from the casing together create a field of deadly fragments (Figs. 5 and 6). Furthermore, because the pre-made fragments are designed to have uniform air resistance when flying they have a more efficient killing effect within a specified range, and the lethality of the whole warhead improves greatly.