Retained bullet removal in civilian pelvis and extremity gunshot injuries: a systematic review.
Clin Orthop Relat Res
; 471(12): 3956-60, 2013 Dec.
Article
em En
| MEDLINE
| ID: mdl-23982410
ABSTRACT
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(®) 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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ossos Pélvicos
/
Ferimentos por Arma de Fogo
/
Corpos Estranhos
Tipo de estudo:
Guideline
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
Clin Orthop Relat Res
Ano de publicação:
2013
Tipo de documento:
Article
País de afiliação:
Estados Unidos