Bullet Extraction from the Sacroiliac Joint with an Arthroscopically Assisted Dual Guidewire Technique: A Case Report

Patients with intra-articular gunshot wounds (GSWs) are presenting with increasing frequency at many trauma centers. These injuries necessitate a specific treatment regimen that includes a thorough irrigation and debridement as well as surgical exploration of the joint, typically through an open approach. The bullet must be removed from the joint because retained bullets and clothing material in joints can cause several complications, including mechanical symptoms, damage to the articular cartilage1, posttraumatic arthritis2, and, rarely, lead poisoning3. Access to the sacroiliac (SI) joint can be challenging given its location and proximity to surrounding vital structures. An open anterior ilioinguinal approach with use of the lateral window technique can increase blood loss and morbidity. The posterior approach to the SI joint allows for limited intra-articular access and has increased rates of wound complications4. Open approaches carry a theoretical increased risk of wound complications (e.g., infection, hematoma, and dehiscence) and can also be very time-consuming. The exposure and closure in cases where the SI joint needs to be exposed are extensive. Although arthroscopic surgery can be more costly, it affords the patient the advantage of a smaller wound, decreased morbidity at the surgical site, and potentially a decreased length of hospital stay5. For these reasons, percutaneous approaches are gaining favor over open approaches. In 2008, Lee et al. were the first to describe the arthroscopic approach to the SI joint utilizing solely a bullet track6. This technique used one guidewire that was drilled through the bullet for extraction. In our case report, we describe the surgical technique that was used to perform an arthroscopically assisted bulletectomy from the SI joint with use of a dual guidewire technique via the bullet track with arthroscopic as well as fluoroscopic guidance. The patient and …