Features of modern gunshot wounds: surgical tactics for repeated wounds

The work is devoted to the analysis of diagnostics and tactics of surgical treatment based on a clinical case of a repeated gunshot bullet wound in the artifi al elbow joint.The patient, a 23-year-old man, received a gunshot wound with destruction of the bones forming the elbow joint, who, after healing of soft tissue wounds, underwent total cement arthroplasty of the elbow joint, the postoperative period was uneventful, and the patient returned to professional activities. However, 4 years after the endoprosthesis replacement, he received a repeated gunshot bullet combined wound of the chest and limbs, while one of the bullets hit the elbow joint endoprosthesis and remained in the soft tissues. The purpose of providing primary surgical care was debridement of wounds and drainage of the pleural cavity. After stabilization of the condition and healing of wounds, a physical and instrumental examination was conducted, it was revealed that the prosthesis was not damaged, and an open removal of the bullet was performed with a favorable outcome.Conclusion Diagnostic and surgical management of blind gunshot and joint injuries after primary arthroplasty is becoming increasingly important as the number of patients with extremity gunshot wounds continues to rise. A foreign body (bullet) in the patient's body requires a clear diagnostic and surgical approach. The incidence of non-removed or involuntarily abandoned bullets has increased in recent years, while existing treatment protocols are outdated or non-existent. The existing literature on gunshot wounds and residual bullet treatment is small, low-powered studies, so clinical studies need to be continued through well-controlled cohort and multicenter studies.