“…10 It has been suggested that conditions that increase metabolic stress, such as surgery, fracture, hyperparathyroidism, infection, illicit drug abuse, alcohol abuse, pregnancy, and lactation, increase the mobilization of lead from the extraarticular missiles. 2,3,11 Other risk factors associated with elevated blood lead levels (BLLs) that have been documented in the literature are the number of retained pellets, duration of missiles retention, and the number of fractures. 12 Several case reports 1,2 and cohorts studies 3,[6][7][8][9][10][11][12] have demonstrated a relationship between missiles and blood lead elevation, and these are well documented in the literature.…”