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European Journal of Trauma and Emergency Surgery

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01-04-2012 | Original Article

Indications for bullet removal: overview of the literature, and clinical practice guidelines for European trauma surgeons

Authors: T. Dienstknecht, K. Horst, R. M. Sellei, A. Berner, M. Nerlich, T. C. Hardcastle

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2012

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.

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Title: Indications for bullet removal: overview of the literature, and clinical practice guidelines for European trauma surgeons
Authors: T. Dienstknecht
K. Horst
R. M. Sellei
A. Berner
M. Nerlich
T. C. Hardcastle
Publication date: 01-04-2012
Publisher: Springer-Verlag
Published in: European Journal of Trauma and Emergency Surgery / Issue 2/2012
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-011-0170-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Indications for bullet removal: overview of the literature, and clinical practice guidelines for European trauma surgeons

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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