Gun shot wounds (GSW) are less common in India than thy are in the USA. There are three types of GSWs.
- High velocity, more than a 1000 ft per second like a rifle shot causing a small entry hole, large cavity of soft tissue damage, and a big exit hole
- Low velocity like a hand gun / revolver cause less soft tissue injury and the bullet is usually embedded in the tissue
- Close range shot gun can cause a lot of damage with wide entry wound from multiple pellets and the wadding which are retained in the tissues.
The indications to remove a bullet are
- Metal fragment with potential to rub on articular surface
- Impede tendon gliding like in the hand
- Pressure on the spinal cord or nerves
- Exposure to body fluids like in the joint or CSF. The idea is that lead can leach out and cause increased lead levels.
- Removal of shotgun wadding
Fractures associated with GSWs are treated like closed fractures unless the soft tissue necrosis or the exposed bone require debridement. We recommend intravenous antibiotics for 24 hours to prevent infection. GSWs through the lower bowel are considered contaminated requiring more aggressive management.
Retained bullet in the left femoral head removed with surgical dislocation and bone and cartilage grafting.