Arthroscopically assisted minimally invasive intraarticular bullet extraction: technique, indications, and results

We describe a new arthroscopically assisted, minimally invasive approach to intraarticular bullet extraction limited in its surgical dissection to the bullet tract itself. This procedure accomplishes intraarticular irrigation and removal of the retained missile without the need for a formal open approach. Additionally, we report on a novel extension of this technique to include bullet removal from the sacroiliac joint.

During a 5-year period (April 2001 to April 2006), 11 patients with retained intraarticular missiles as a result of low-velocity gunshot wounds were treated at our institution with attempted arthroscopically assisted minimally invasive bullet extraction. All patients were male with a mean age of 22.3 years (range, 17-45). Anatomic location of the retained bullets included the knee (6), hip (4), and sacroiliac joint (1).

We report a 90.9% success rate of arthroscopically assisted intraarticular bullet extraction from the hip, knee, and sacroiliac joint. One case involving the knee required conversion to an open approach to avoid iatrogenic osseous damage to the posterior aspect of the femoral condyle.

Surgical extraction of retained intraarticular missiles from low-velocity handguns should be performed to minimize the risk of mechanical arthritis, synovitis, and lead toxicity. Arthroscopically assisted bullet extraction using the bullet tract with a minimally invasive approach should be considered when it can be safely accomplished without iatrogenic damage associated.