Lead intoxication and traumatic arthritis of the hip secondary to retained bullet fragments. A case report

Failure to remove lead projectiles which enter and remain in major joints can cause not only arthritis but also systemic absorption of the lead and signs and symptoms of lead intoxication. The following case report is that of a man in whom both sequelae were evident. Renal failure developed that was successfully treated. Surgical removal of the lead and total hip replacement were required. Rapid encapsulation of most foreign bodies composed of lead occurs by fibrosis, and this process essentially removes them from exposure to circulating body fluid. When lead is exposed to synovial fluid, this removal process does not take place because synovial fluid serves as a solvent for the lead and allows it to enter the systemic circulation. The chemical treatment of the lead poisoning in the patient reported on here with the several drugs that are now used (EDTA, dimercaprol, and penicillamine) had to be coordinated with treatment of the other complications: anemia, encephalopathy, and renal failure. The orthopaedic procedure of reconstruction of the hip, however, had as a primary objective the removal of the particles of lead that were actively being dissolved by the synovial fluid. Removal of those particles was an important feature of the treatment, but it should be pointed out that there was no need to remove other lead particles in soft tissues where there was no synovial fluid to dissolve them.