A
Leave the bullet in situ as it is not intra-articular or causing direct neurovascular compromise.
B
Immediate surgical extraction to prevent systemic lead toxicity.
C
Extraction of the bullet only if it is palpable within 5 cm of the skin surface.
D
Routine debridement of the bullet track and prophylactic extraction to prevent osteomyelitis.
Explanation:The correct option is 'a'. In low-velocity civilian gunshot wounds, retained bullets do not routinely require extraction. The heat generated during firing typically sterilizes the projectile. Indications for bullet removal include intra-articular location (to prevent lead arthropathy and joint mechanical damage), location within the spinal canal, impingement on a nerve or vessel, or location in an abscess cavity.
Reference: Bartlett CS. Clinical update: gunshot wound ballistics. Clin Orthop Relat Res. 2003;(408):28-57.