Lead arthropathy: arthritis caused by retained intra-articular bullets.

Sclafani, Salvatore J. A.; Vuletin, J.C.; Twersky, Jack

doi:10.1148/radiology.156.2.4011890

Cited by 62 publications

(29 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, all authors agree that the arthroscopic removal of foreign body and joint lavage after sustaining an injury is a safe and useful method to help prevent further complications (mechanical disorder, chronic synovitis and infection) (4,5,12).…”

Section: Discussionmentioning

confidence: 99%

Missile Injury of the Knee Joint

Golubović¹,

Popovic²,

Milenković³

et al. 2013

Acta Facultatis Medicae Naissensis

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Missile Injury of the Knee Joint

Golubović¹,

Popovic²,

Milenković³

et al. 2013

Acta Facultatis Medicae Naissensis

View full text Add to dashboard Cite

“…Intra-articular debris has potential to develop septic arthritis and lead toxicity [62][63][64][65][66][67][68][69]. Tornetta and Hui arthroscopically evaluated 33 gunshot injuries to the knees and found a 42 % incidence of meniscal damage and 15 % incidence of cartilage damage all in the absence of radiographic evidence [37].…”

Section: Antibiotics and Debridement For Low-velocity Joint And Pelvimentioning

confidence: 99%

“…Damage to the articular architecture and the presence of loose bodies have potential to create a shift in weight-bearing dynamics with subsequent acceleration of arthritis. Although rare, systemic lead toxicity can result because synovial fluid acts as a lead solvent leading to non-specific symptoms of fatigue, anemia, headaches, peripheral neuropathy, abdominal pain, and encephalopathy as systemic lead concentrations rise [62][63][64][65][66][67][68][69]. In light of such articular damage, potential for loose bodies, and risks for local infection and systemic plumbism, the literature suggests articular irrigation and debridement [36-38, 39••, 40].…”

Section: Antibiotics and Debridement For Low-velocity Joint And Pelvimentioning

confidence: 99%

Gunshot-induced fractures of the extremities: a review of antibiotic and debridement practices

Sathiyakumar

Thakore

Stinner

et al. 2015

Curr Rev Musculoskelet Med

View full text Add to dashboard Cite

The use of antibiotic prophylaxis and debridement is controversial when treating low-and high-velocity gunshotinduced fractures, and established treatment guidelines are currently unavailable. The purpose of this review was to evaluate the literature for the prophylactic antibiotic and debridement policies for (1) low-velocity gunshot fractures of the extremities, joints, and pelvis and (2) high-velocity gunshot fractures of the extremities. Low-velocity gunshot fractures of the extremities were subcategorized into operative and nonoperative cases, whereas low-velocity gunshot fractures of the joints and pelvis were evaluated based on the presence or absence of concomitant bowel injury. In the absence of surgical necessity for fracture care such as concomitant absence of gross wound contamination, vascular injury, large soft-tissue defect, or associated compartment syndrome, the literature suggests that superficial debridement for low-velocity ballistic fractures with administration of antibiotics is a satisfactory alternative to extensive operative irrigation and debridement. In operative cases or those involving bowel injuries secondary to pelvic fractures, the literature provides support for and against extensive debridement but does suggest the use of intravenous antibiotics. For high-velocity ballistic injuries, the literature points towards the practice of extensive immediate debridement with prophylactic intravenous antibiotics. Our systematic review demonstrates weak evidence for superficial debridement of low-velocity ballistic fractures, extensive debridement for high-velocity ballistic injuries, and antibiotic use for both types of injury. Intra-articular fractures seem to warrant debridement, while pelvic fractures with bowel injury have conflicting evidence for debridement but stronger evidence for antibiotic use. Given a relatively low number of studies on this subject, we recommend that further highquality research on the debridement and antibiotic use for gunshot-induced fractures of the extremities should be conducted before definitive recommendations and guidelines are developed.

show abstract

“…Of those, 48 were Level V evidence, reducing the count to seven studies; hand searching the bibliographies of these yielded one additional study. The final number of studies included in this review therefore was eight, including seven Level IV studies (case series) [1,2,11,15,19,22,28] and one Level III study (retrospective study with a control group) [30] (Table 1).…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…Sclafani et al [28] reported a retrospective case series of 14 patients with retained intraarticular bullets. Patients were seen at between 6 and 7 weeks from injury.…”

Section: Selected Indications For Bullet Removalmentioning

confidence: 99%

Retained Bullet Removal in Civilian Pelvis and Extremity Gunshot Injuries: A Systematic Review

Riehl

Sassoon

Connolly

et al. 2013

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Although gunshot injuries are relatively common, there is little consensus about whether retained bullets or bullet fragments should be removed routinely or only in selected circumstances. Questions/purposes We performed a systematic review of the literature to answer the following questions: (1) Is bullet and/or bullet fragment removal from gunshot injuries to the pelvis or extremities routinely indicated? And, if not, (2) what are the selected indications for removal of bullets and/or bullet fragments? Methods A search of the English-language literature on the topic of gunshot injury and bullet removal was performed using the National Library of Medicine and MEDLINE 1 and supplemented by hand searching of bibliographies of included references. Studies were included if they provided clinical data on one or both of our study questions; included studies were evaluated using the levels of evidence rubric. Most studies on the subject were expert opinion (Level V evidence), and these were excluded; one Level III study and seven Level IV studies were included.Results No studies provided a rationale for routine bullet removal in all cases. The studies identified bullet fragment removal as indicated acutely for those located within a joint, the palm, or the sole. Chronic infection, persistent pain at the bullet site, and lead intoxication were reported as late indications for bullet removal. Conclusions The evidence base for making clinical recommendations on the topic of bullet and bullet fragment removal after gunshot injury is weak. Level I and II evidence is needed to determine the indications for bullet removal after gunshot injury.

show abstract

Lead arthropathy: arthritis caused by retained intra-articular bullets.

Cited by 62 publications

References 0 publications

Missile Injury of the Knee Joint

Missile Injury of the Knee Joint

Gunshot-induced fractures of the extremities: a review of antibiotic and debridement practices

Retained Bullet Removal in Civilian Pelvis and Extremity Gunshot Injuries: A Systematic Review

Contact Info

Product

Resources

About