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You've got a single ballistic wound to the thigh with a retained bullet.

There's no bleeding, no fracture, and no deficits on exam.

You tell the patient, you're definitely lucky.

You discharge them home, advise them to follow up as needed, and you rush back to your case

in the OR.

As trauma surgeons, this is definitely a regular occurrence.

The patient was in fact lucky, but it doesn't change the fact that they still

have a bullet in them. A bullet that can cause pain, psychological distress, and a rare instance,

serious lead poisoning. So welcome back to Behind the Knife. I'm Patrick Georgoff, and today we're

tackling a topic every trauma surgeon encounters, but almost none of us are formally taught,

and that's retained ballistic fragments.

So we'll cover the epidemiology, when to remove and when to leave them alone, how to handle

bullets as forensic evidence, the underappreciated psychological toll on our patients, and

the lead toxicity that can show up decades later. So joining me of Dr. Teddy Cusio from UT Houston,

Dr. Madre Supermanian,

a colleague of mine at Duke and a gun violence survivor, and our beloved Duke ACS fellow, Dr. Tyler Simpson.

Tyler, step the stage for us, why should trauma providers care about this topic?

Thanks, Dr. George, Ralph. So as we all know, firearm injuries are still a significant public health concern in the United States.

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