JBJS | Article

The Journal of Bone & Joint Surgery, Volume 91, Issue 8

Case Reports | August 01, 2009

Lead Toxicity Associated with a Gunshot-Induced Femoral Fracture: A Case Report

Paul J. Dougherty, MD¹; Marnix van Holsbeeck, MD²; Theodore G. Mayer, MD²; A. Joseph Garcia, MD²; Soheil Najibi, MD, PhD²

¹ Department of Orthopaedic Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109. E-mail address: pauldoug@med.umich.edu
² Departments of Orthopaedic Surgery (S.N.), Radiology (M.v.H.), Pathology (T.G.M.), and Emergency Medicine (A.J.G.), Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202

The Journal of Bone & Joint Surgery. 2009; 91:2002-2008 doi:10.2106/JBJS.H.01077

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Lead toxicity due to a bullet or bullet fragment is a rare complication of gunshot wounds^1-17. Surgeons who manage patients with these injuries are aware of lead toxicity in association with lead arthropathy^4,11,18-26, but cases that involve lead toxicity due to extra-articular lead fragments in the extremities are unusual. The presence of bullet fragments in tissue can increase the serum concentration of lead to above average, but not to the levels seen in patients with lead toxicity^15,16,27. Cysts associated with a gunshot wound to bone^28,29, the joints^19,30-32, or the spine^8,33 have been described. We describe the case of a patient with lead toxicity due to an extra-articular cyst associated with retained lead fragments after a gunshot-induced fracture of the femoral shaft. The cyst encasing the bullet fragments developed by twenty-one months after the injury. The patient was informed that data concerning the case would be submitted for publication and he consented.

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cyst ; femoral fractures ; lead poisoning ; gunshot wounds

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These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.

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