Puncture damage is damage caused when something enters the body, such as a knife, a spear, an arrow, or a bullet. This type of injury always requires Surgery to remove the object before healing can begin. The success rank of this surgery needs to beat the rank of the injury or it only winds up causing 1 Fortitude damage per attempt. This is a regular combat-type of damage, and as such the rules for its use can be found under Physical Damage, but something may happen (such as a character falling off a roof and landing on a fence, being Punctured by one of the fence posts) that the GM will have to figure out on his own. See Unexpected Damage .