Retained Bullet Fragments Linked to Long-Term Health Effects in Gunshot Survivors

Survivors of firearm injuries often live with retained bullet fragments that remain inside the body after a non-fatal gunshot wound. These fragments can cause chronic pain, mobility problems, and lead poisoning when made from lead or lead alloy cores.

Oronde McClain was shot in the head at age 10 during a drive-by shooting. He spent eight weeks in a coma, had one-third of his brain removed, and still lives with 36 retained bullet fragments in his brain and skull. McClain experiences seizures and partial paralysis on his right side.

A study estimates that about 75 percent of survivors of firearm injuries live with retained bullet fragments. Changes in ammunition design, including increased use of hollow-tip bullets, have raised this risk because these bullets create more tissue damage and are less likely to exit the body.

Retained fragments can lead to organ damage if they migrate. Some case reports link them to soft tissue cancers in the brain, lungs, and skin. Lead toxicity is another concern, with symptoms that include nerve damage, mood disturbances, headaches, elevated blood pressure, and anemia.

Jamaji Nwanaji-Enwerem, emergency medicine physician and professor of environmental health, said fragments near joints may increase lead absorption because joint fluid can accelerate metal degradation. A CDC report found that retained bullet fragments accounted for about 5 percent of cases with blood lead levels of 80 or higher.

Randi Smith, associate professor of surgery and trauma surgeon at Emory University, found that people with retained bullet fragments had higher depression scores. Smith said some survivors view the fragments as constant reminders of trauma, while others see them as symbols of survival.

McClain, now director of the Philadelphia Center for Gun Violence Reporting's Survivor Connection, said many survivors he works with experience emotional distress when they can feel or see fragments under the skin. He noted that patients are often not told about lead risks or long-term effects.