T Dienstknecht1, K Horst2, R M Sellei2, A Berner3, M Nerlich3, T C Hardcastle4. 1. Department of Orthopaedic Trauma, University of Aachen Medical Center, 30 Pauwels Street, 52074, Aachen, Germany. tdienstknecht@ukaachen.de. 2. Department of Orthopaedic Trauma, University of Aachen Medical Center, 30 Pauwels Street, 52074, Aachen, Germany. 3. Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany. 4. Departments of Health KZN and Surgery, Trauma Service, University of Kwazulu-Natal, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
Abstract
PURPOSE: The incidence of gunshot wounds from civilian firearms is increasing. Despite this fact, guidelines on indications for bullet removal are scarce. In this analysis, we combine an overview of the available literature in these rare entities with our experiences in our own clinical practices. METHODS: We conducted a systematic literature search of computerized bibliographic databases (Medline, EMBASE, and the Cochrane Central Register). The local experience of the authors was reviewed in light of the available literature. RESULTS: 145 full-text articles were suitable for further evaluation. Only six retrospective studies were available, and no prospective study could be retrieved. Most of the articles were case reports. In the South African co-author's own clinical practice, approximately 800 patients are treated per year with gunshot wounds. CONCLUSIONS: In summary, there are only a few clear indications for bullet removal. These include bullets found in joints, CSF, or the globe of the eye. Fragments leading to impingement on a nerve or a nerve root, and bullets lying within the lumen of a vessel, resulting in a risk of ischemia or embolization, should be removed. Rare indications are lead poisoning caused by a fragment, and removal that is required for a medico-legal examination. In all other cases the indication should be critically reviewed.
PURPOSE: The incidence of gunshot wounds from civilian firearms is increasing. Despite this fact, guidelines on indications for bullet removal are scarce. In this analysis, we combine an overview of the available literature in these rare entities with our experiences in our own clinical practices. METHODS: We conducted a systematic literature search of computerized bibliographic databases (Medline, EMBASE, and the Cochrane Central Register). The local experience of the authors was reviewed in light of the available literature. RESULTS: 145 full-text articles were suitable for further evaluation. Only six retrospective studies were available, and no prospective study could be retrieved. Most of the articles were case reports. In the South African co-author's own clinical practice, approximately 800 patients are treated per year with gunshot wounds. CONCLUSIONS: In summary, there are only a few clear indications for bullet removal. These include bullets found in joints, CSF, or the globe of the eye. Fragments leading to impingement on a nerve or a nerve root, and bullets lying within the lumen of a vessel, resulting in a risk of ischemia or embolization, should be removed. Rare indications are lead poisoning caused by a fragment, and removal that is required for a medico-legal examination. In all other cases the indication should be critically reviewed.
Authors: Plínio Duarte Mendes; Edgar Garcete Fariña; Guilherme Brasileiro de Aguiar; Carlos Telles; Marcus André Acioly Journal: J Craniofac Surg Date: 2010-07 Impact factor: 1.046
Authors: Paulo Roberto de Madureira; Eduardo Mello De Capitani; Ronan José Vieira; Alice Momoyo Sakuma; Adriana Safioti Toledo; Suely Moreira Mello Journal: Sao Paulo Med J Date: 2009-01 Impact factor: 1.044
Authors: Eduardo Cavalcanti Lapa Santos; Rodrigo Mezzalira Tchaick; Diogo Luiz de Magalhães Ferraz; João Paulo Segundo de Paiva Oliveira; Fernando Augusto Marinho Dos Santos Figueira; George Augusto da Fonseca Carvalho Antunes Lima Journal: Braz J Cardiovasc Surg Date: 2017 Nov-Dec