A Posterior Arthroscopic Approach to Bullet Extraction from the Hip

Abstract

A 22-year-old male sustained a gunshot injury to the left hip region. The bullet lodged in the articular surface of the femoral head posterosuperomedially. The location of the bullet within the hip joint stimulated the performance of an arthroscopy of the hip through a posterior approach. The authors are unaware of any other report in the literature describing such an approach. To minimize the dangers, a limited posterior incision was made and deepened through the short rotators. The arthroscope was introduced through the incision to perforate the posteroinferior portion of the hip joint capsule. The bullet was easily visualized with a 70° arthroscope. Positioning at the joint and traction are vital components to visualization. The use of three-dimensional CT scanning is an aid to the graphic understanding of the bullet's pathway and relations to the surfaces of the hip joint.