Table 1.
Supporting evidence addressing the study questions
| Study | Year | Study description | Level of evidence | Outcome |
|---|---|---|---|---|
| Watters et al. [30] | 2011 | Retrospective cohort of 47 patients with pelvic GSIs Primary outcome was incidence of infection related to pelvic GSIs at least 1 year after injury |
III | 34 patients had retained bullet or bullet fragments One patient developed an infection Retained bullets did not increase the risk of infection, even after penetrating the gastrointestinal tract organs |
| Rehman et al. [22] | 2011 | Retrospective cohort of 84 patients with GSIs and pelvic fractures, of which 59% had a perforated bowel | IV | Infection occurred in only one patient with intraarticular and intestinal injury |
| Bartkiw et al. [2] | 2010 | Retrospective cohort of 42 patients with GSIs to the hip or pelvis | IV | Pelvic GSI rarely causes pelvic injury Intraarticular bullet fragments should be removed |
| Mazotas et al. [15] | 2012 | Retrospective cohort of 107 patients with GSIs and retained bullet fragments Indications for bullet removal were chronic pain, infection, and cosmetic concerns | IV | 34% of patients with followup experienced long-term complications related to the foreign body; 20% of patients with followup ultimately required bullet removal |
| Sclafani et al. [28] | 1985 | 14 patients with GSIs and retained intraarticular bullets | IV | Radiographic, gross, and microscopic changes were evident by 6 weeks and caused the authors to recommend early removal of intraarticular bullets |
| Ashby [1] | 1974 | Retrospective cohort of 7 patients with low-velocity GSIs to the knee | IV | Recommendation for débridement and bullet or bullet fragment removal in cases where missiles remain intraarticular |
| Lee et al. [11] | 2008 | Retrospective cohort of 11 patients with GSIs and intraarticular missiles treated with arthroscopic removal | IV | Arthroscopic bullet extraction is safe and effective in most cases where bullets come to rest in an intraarticular location |
| Parisien and Esformes [19] | 1984 | Retrospective cohort of 8 patients with GSIs to the knee who underwent arthroscopic débridement and bullet removal | IV | Arthroscopy allowed for bullet removal and is safe and effective |
GSI = gunshot injury.