Abstract
BackgroundWith increasing prevalence of gunshot injuries we are seeing more patients with retained bullet fragments lodged in their bodies. Embedded lead bullets are usually considered inert after their kinetic energy has dissipated hence these are not removed routinely. However, exposure of any foreign body to synovial fluid may lead to rapid degradation and hence result in systemic absorption, causing local and systemic symptoms. We present the case of a thirty year old man who came to our out patient department with a history of progressive, severe hip pain ten years after a gun shot injury to his right hip.ConclusionThe common belief that intraarticular bullets should not be removed has no benefit and may result in unwanted long term complications.
Highlights
With increasing prevalence of gunshot injuries we are seeing more and more patients with retained bullet fragments lodged in their bodies [1]
Intra-articular bullet fragments behave differently due to direct contact with synovial fluid
Lead poisoning from retained intra articular bullets has been recognized in the literature since 1867 [3,1113]
Summary
With increasing prevalence of gunshot injuries we are seeing more and more patients with retained bullet fragments lodged in their bodies [1]. Lead poisoning from retained intra articular bullets has been recognized in the literature since 1867 [3,1113]. Radiographic identification of intra-articular bullet fragments should prompt an urgent orthopedic consultation [9] as timely removal can prevent both lead arthropathy and systemic toxicity [10]. Radiographs at the time of injury confirmed the presence of bullet around the hip joint. He was managed conservatively at that time. Current radiographs revealed a bullet fragment inside the hip joint with severe degenerative arthritis (figure 1). The loose bullet fragment was removed and an un-cemented total hip arthroplasty (Protek, Mathys Medical) was performed
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