Nothing bothers you
A person learns about the fragment only from an X-ray: there is no pain, the arm or leg works as usual.
CONDITION / WOUNDS AND INJURIES
Debris and foreign bodies in tissues.
Fragments and foreign bodies in tissues — shrapnel, bullets or their fragments, glass, wood, or pebbles remaining in the muscles and under the skin of the torso, arms, or legs after an injury. It is not necessary to remove every fragment — this is decided after an examination and CT scan.
CONCEPTUAL VISUALIZATION- What it is
- Shrapnel, bullets and their fragments, glass, wood, or pebbles in the soft tissues of the torso and limbs.
- To take out
- Not always: fragments in a joint, on the palm, or on the sole are removed, as well as those that cause pain, inflammation, or increase blood lead levels.
- MRI
- For metal fragments — only after risk assessment by a radiologist; fragments are located on a CT scan.
- Lead
- Bullet fragments can increase lead levels in the blood, so the doctor may prescribe a test.
01 / WHAT IS ITWhat is
What is
foreign bodies in tissues.
Doctors call foreign bodies anything that is foreign to the body and has gotten stuck in the muscles or under the skin after an injury. After explosions, these are primarily metal fragments: in a study of 20 injured soldiers, 93% of the fragments in the images were metal (889 out of 958), and most often the trunk and arms were affected (45% of the injured).
Other types also occur: glass, wood, pebbles, plastic. Glass and wood are often missed during examination and on a regular X-ray. Around any foreign body, the body forms inflammatory tissue, trying to isolate it.
Thus, the surgeon decides not how to remove all the fragments from the arms, legs, or trunk, but which of them are truly worth removing. In the same study of injured soldiers, only 3% of the fragments were removed, and these were not necessarily the largest or most superficial ones.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow they give about themselves
How they give about themselves
know the debris.
Complications can be early or late: a fragment may not cause trouble for a long time, and then become inflamed or start to hurt.
Tightness and pain
A hard mass can be felt under the skin, it hurts during movement or pressure. Persistent pain at the site of the bullet is one of the reasons to remove it.
Inflammation
The skin over the fragment becomes red and swollen, pus is released, an old scar or wound opens again. Among complications of foreign bodies, infection occurs more often than others.
Fire woundJoint pain
Fragment in or near a joint: the joint hurts, swells, and moves worse. Lead from a bullet in the joint can cause its inflammation.
Numbness or weakness
Fragment near a nerve: fingers become numb, the hand or foot weakens. If this appeared immediately after a fresh wound — call 103.
Hand nerve injuryComplaints due to lead
Irritability, headache, memory deterioration, abdominal and joint pain, tingling in the limbs. In a study of 45 wounded people with bullet fragments, such complaints occurred more frequently than in people without fragments.
Face or neck
Fragments in the face and neck have their specific features — a separate page is dedicated to them.
Shrapnel in the face and neck03 / REASONSWhere do they come from?
Where do they come from?
debris
The material of the fragment determines whether it is visible on an image, whether it is prone to infection, and whether MRI is safe.
Explosions
Fragments of shells, mines, and drones. Among 53 wounded people in the war in Ukraine who were treated in a Spanish hospital, 83% were injured by an explosion.
Bullets
Bullets and their fragments may contain lead, and some military bullets may also contain steel or nickel; this is important for MRI.
Glass, wood, pebbles
An explosion or impact drives them into the wound along with shrapnel. They are easily missed during examination and on a standard X-ray.
Contaminated wound
Along with the fragment, dirt and microbes enter the wound. In the same 53 injured, wound infection was associated with foreign bodies in the tissues, damaged bone, and lack of skin.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
If the fragment has been in the hand, leg, or torso for a long time and does not cause any problems, usually a scheduled visit is enough. A fresh wound, signs of sepsis, or tetanus require immediate assistance.
103 immediately if:
- bleeding from the wound does not stop, despite pressing;
- the blood is gushing, bright red;
- after the injury, the area near the wound is numb or difficult to move;
- the wound is very large or deep;
- a foreign object is stuck in the wound — do not remove it yourself and do not press on it;
- breathing is very rapid or difficult;
- confusion or slurred speech;
- skin is blue, pale, or blotchy;
- jaw locks or swallowing is difficult;
- painful cramps or muscle stiffness;
- convulsions
Do not delay a visit to the doctor:
On the same day: The skin around the fragment is hot, swollen, red, increasingly painful, or pus is flowing from the wound; you have a fever, chills, or feel unwell; dirt or soil remains in the wound that cannot be washed out; the wound is fresh, and you are not sure you are vaccinated against tetanus. In the coming days: Numbness or weakness gradually appears near an old fragment; the joint in which or near which the fragment lies hurts and moves worse. Planned: A fragment can be felt under the skin, it is painful, interferes with movement, or simply worries you — come to a surgeon with a CT scan, and together you will decide whether to remove it. If fragments remain in the body after a gunshot wound, ask the doctor if you should have your blood tested for lead.
05 / DIAGNOSTICSHow to find
How to find
debris
- Conversation and documents
When and with what you were injured, which surgeries and fragment removals have already been done, what is bothering you now; take hospital discharge summaries and discs with images.
- Review
The surgeon assesses scars, indurations, signs of inflammation, joint movements, sensitivity, and strength.
- X-ray and CT scan
For deep fragments, a CT scan is required: it shows where the fragments are located and how close they are to joints and blood vessels. If a fragment is less than 5 cm from a joint, the doctor checks whether the joint capsule is damaged.
- ultrasound
Shallow fragments are visible on ultrasound regardless of the material — whether metal, glass, or wood. In a meta-analysis, ultrasound detected an average of 72% of foreign bodies in soft tissues.
- MRI - with caution
In a laboratory study of 29 military and police bullets, 8 — made of steel or nickel — shifted significantly in a magnetic field. Therefore, MRI for metal fragments is performed only after a risk assessment by a radiologist. When undergoing an MRI of any body part, inform the staff about any fragments.
- Lead testing
If fragments of bullets remain in the body, the doctor may prescribe a blood test for lead and repeat it.
06 / TREATMENTWhen the wreckage
When the wreckage
are removed
There is little evidence that fragments must necessarily be removed. Research has not found grounds to routinely remove all bullets — they are removed based on indications. The surgeon explains what the operation will achieve and what risks it entails before you agree.
01
Usually deleted
When a fragment is already causing harm or threatens to do so.
- In a joint
- Fragments of a bullet in a joint are removed shortly after the injury. In a classic series of 14 patients who sought help due to pain and stiffness in a joint with a bullet in it, 12 showed signs of lead arthritis in imaging.
- On the palm or sole
- Bullet fragments on the palm or sole are also removed shortly after the injury.
- Infection or persistent pain
- Chronic infection and persistent pain at the bullet site are reasons to remove it later.
- High lead
- According to a meta-analysis, if the blood lead level is higher than 5 µg/dL, attempts are made to remove the fragments, provided it does not worsen the condition.
02
You can observe
When searching for and removing the fragment causes more harm than the fragment itself.
- Without symptoms
- Some fragments can be left. Removal should be considered if the risk of complications is high.
- reviews
- Experts recommend periodically checking blood metal levels, repeating imaging, and selectively removing fragments.
03
Fragments of bullets and lead
- risk
- Lead poisoning from bullets in the body is uncommon, but it is most likely recognized less often than it occurs. The likelihood increases if the bullet shattered a bone, there are many fragments, or they have been in the body for a long time; the diagnosis is sometimes made only months or years after the injury.
- Even outside of a joint
- In a study of 45 injured people with fragments for more than 6 months, the average blood lead level was 9.01 µg/dL compared to 2.17 µg/dL in people without fragments.
- Control
- According to a meta-analysis, in fractures or multiple fragments, the lead level is checked every 3 months during the first year. There are no uniform rules for monitoring yet.
- Medicines
- Drugs that remove lead, according to experts, are of little help without symptoms of poisoning or very high levels (over 80 µg/dL) and may cause harm.
04
How to delete
- Planning
- The fragment is first precisely located using CT or ultrasound. If the joint capsule is damaged, the joint is washed and cleaned.
- Tetanus
- For a fresh wound, the doctor checks tetanus vaccination and administers the vaccine if necessary.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Fragments and foreign bodies in the trunk and limb tissues are treated at the Doctor Valikhnovskyi Institute of Surgery in the "Surgery of Gunshot Injuries" department. The clinic decides whether to remove the fragment, removes it, and restores the tissues; if the lead level is high, its treatment is managed by a specialized doctor.
CLINIC SERVICE
Surgery of gunshot injuries
Bullet, shrapnel, and landmine injuries — from a fresh wound to restoration of tissue, form, and function.
View service
What we do for this condition
- Removal of foreign bodies — if a fragment causes pain, infection, is in a joint or near a nerve, or if blood lead levels rise; decisions are made after examination and CT.
- Follow-up — fragments without symptoms are often left in place and periodically monitored; the decision is reviewed if pain or inflammation appears.
- Surgical treatment and closure of wounds — a wound that does not heal around a fragment is cleaned, the fragment is removed if necessary, and only then is it closed.
- Suture and nerve grafting — if a fragment damages a nerve, it is sutured or the defect is covered with a graft from the patient’s own nerve.
- Scar excision, Z-plasty — scars that tighten the skin and restrict movement are excised and closed with local flaps.
- Lipofilling — the patient’s own fat is transplanted under indented scars on the arms, legs, or torso.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend the CT, discharge summaries, and photos of the scars — the doctor will look in advance at where the fragments are in the body.
- ConsultationThe surgeon examines the hand, leg, or torso, checks movements and sensitivity; a new CT scan is done if there is no previous one or if the old one is outdated.
- PlanDecide whether to leave the fragment under observation or remove it; if removing — through which incision and whether to combine this with scar correction.
- SurgeryRemoval of the fragment, wound care, if necessary — nerve suture or scar correction.
- Follow-upAfter surgery — follow-up visits; fragments left in the body are periodically checked during examination and imaging.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is it necessary to remove all fragments from the body?
No. Fragments are removed if they are in a joint, on the palm or sole, as well as those that cause pain, inflammation, lie near a nerve, or raise blood lead levels. Others can be left and monitored. The final decision is made after an examination and CT scan.
Is it possible to have an MRI if there is a fragment in the body?
First, the risk must be assessed by a radiologist, as fragments made of steel or nickel can be moved by the magnet. To locate fragments in the hand, leg, or torso, a CT scan is usually performed. On the MRI form, you must indicate that there is metal in the body.
What are the risks of lead from a bullet in the body?
Lead poisoning from bullet fragments is rare and may not appear immediately but after months or years. The risk is higher if there are multiple fragments, a fracture, or a fragment in a joint.
How often should lead be checked?
There are no universal rules. According to a meta-analysis, with fractures or multiple fragments, tests are done every 3 months during the first year; after that — as the doctor advises.
Fragment in the joint — what to do?
See a surgeon: fragments in a joint are usually removed because lead from a bullet can cause joint inflammation.
An old fragment has started to inflame. What to do?
Consult a surgeon the same day: among complications of foreign bodies, infection occurs most often. A fragment around which there is inflammation is usually removed.
Is a tetanus vaccination needed?
If the wound is fresh and you are not sure you are vaccinated, see a doctor the same day: they will check and, if necessary, administer the vaccine.
Sources
18 sources · systematic reviews, meta-analyses, expert recommendations and the NHSshowCollapse
- Retained bullet removal in civilian pelvis and extremity gunshot injuries: a systematic reviewClinical Orthopaedics and Related Research, 2013doi:10.1007/s11999-013-3260-8 ↗
- Characterisation of retained energised fragments from explosive devices in military personnelBMJ Military Health, 2022doi:10.1136/bmjmilitary-2021-001825 ↗
- The management of embedded metal fragment patients and the role of chelation Therapy: A workshop of the Department of Veterans Affairs-Walter Reed National Medical CenterAmerican Journal of Industrial Medicine, 2020doi:10.1002/ajim.23098 ↗
- Periarticular blast wounds without fracture a prospective case seriesJournal of Orthopaedic Surgery and Research, 2024doi:10.1186/s13018-024-04598-y ↗
- Lead arthropathy: arthritis caused by retained intra-articular bulletsRadiology, 1985doi:10.1148/radiology.156.2.4011890 ↗
- Lead Toxicity Risks in Gunshot VictimsPLoS One, 2015doi:10.1371/journal.pone.0140220 ↗
- Extra-Articular Retained Missiles; Is Surveillance of Lead Levels Needed?Military Medicine, 2018doi:10.1093/milmed/usx076 ↗
- Retained bullets and lead toxicity: a systematic reviewClinical Toxicology, 2022doi:10.1080/15563650.2022.2116336 ↗
- Lead toxicity from retained bullet fragments: A systematic review and meta-analysisJournal of Trauma and Acute Care Surgery, 2019doi:10.1097/TA.0000000000002287 ↗
- Multimodality Imaging of Foreign Bodies: New Insights into Old ChallengesRadiographics, 2020doi:10.1148/rg.2020200061 ↗
- Diagnostic Accuracy of Ultrasonography in Retained Soft Tissue Foreign Bodies: A Systematic Review and Meta-analysisAcademic Emergency Medicine, 2015doi:10.1111/acem.12714 ↗
- Foreign Bodies in the Skin: Evaluation and ManagementAmerican Family Physician, 2020pubmed.ncbi.nlm.nih.gov/32538598 ↗
- Magnetic Field Interactions of Military and Law Enforcement Bullets at 1.5 and 3 TeslaMilitary Medicine, 2016doi:10.7205/MILMED-D-15-00246 ↗
- Characterization of wound infections among patients injured during the Ruso-Ukrainian war in a Role 4 hospitalEnfermedades Infecciosas y Microbiología Clínica (English ed.), 2024doi:10.1016/j.eimce.2024.06.002 ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
- TetanusNHS, 2026nhs.uk/conditions/tetanus ↗
- MRI scanNHS, 2025nhs.uk/tests-and-treatments/mri-scan ↗
The figures on the page are from these sources.
Debris remained
In the body?
Send the CT, discharge summaries, and photos. The surgeon will advise whether the fragment needs to be removed and how to do it.