@article{ref1,
title="Retained bullet removal in civilian pelvis and extremity gunshot injuries: A systematic review",
journal="Clinical orthopaedics and related research",
year="2013",
author="Riehl, John T. and Sassoon, Adam and Connolly, Keith and Haidukewych, George J. and Koval, Kenneth J.",
volume="471",
number="12",
pages="3956-3960",
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.<p /> <p>Language: en</p>",
language="en",
issn="0009-921X",
doi="10.1007/s11999-013-3260-8",
url="http://dx.doi.org/10.1007/s11999-013-3260-8"
}