The ballistic fist is one of the most powerful Unarmed weapons in the game. It consists of a wrist-mounted shotgun, with a pressure plate trigger worn over the knuckles, which fires when a punch connects with the target. This amplifies the damage given due to the power of the user's fists and the deadly ballistics from the mounted gun.
Despite firing shotgun shells upon a successful hit, the weapon does not drain 20 gauge or 12 gauge shells from the player's inventory, making the source of the weapon's ammo supply a mystery.
If the Ranger Takedown is used with this weapon, the target of the attack will take normal damage even though the pressure plate would not be touched. In third person, the player character hits with their leg. In first person, they use their palm, which would also be in the direct path of the shotgun.
When using the Khan Trick, the sand thrown with this move shares the same explosion animation with the successful ballistic fist strike, although the pressure plate is left untouched.
When using the Scribe Counter the explosion comes from the player's left hand, even though the ballistic fist is worn on the right.
When the special attack Stomp is used in V.A.T.S., the explosion appears to originate from the player's foot. This can produce humorous results, such as flinging a corpse's limbs away in differing directions due to the explosion.
Despite the nature of the weapon, it can be used to make silent sneak kills.