Registry Tracks Effects of Embedded Metal Fragments

By Samantha L. Quigley
American Forces Press Service

Sept. 30, 2008 - A Defense Department registry is helping officials gather data to be sure the long-accepted practice of leaving embedded metal fragments in wounded warriors' bodies as long as vital organs aren't threatened is valid. The Armed Forces Institute of Pathology created the Embedded Metal Fragments Registry in December.

"In general, we've [always] felt that metal fragments in a body, if they're smaller than a certain size ... and they're not in a vital area of the body, it's OK to leave them in," said Dr. Michael Kilpatrick, DoD's deputy director for force health protection and readiness. "That's been that way for, actually, centuries, [but] we want to be able to validate that with actual data."

To date, the registry deals only with wounded servicemembers from Operations Iraqi and Enduring Freedom.

The military's interest in the effects of embedded metal fragments began in the early 1990s after Gulf War veterans reported health concerns, Kilpatrick said. During the Gulf War, servicemembers used munitions made with depleted uranium. The military had studied the effects of firing munitions made from depleted uranium, but not the effects of being hit with them.

Several servicemembers were hit with these munitions in combat accidents, and looked to the depleted uranium as a possible cause of illnesses Gulf War veterans were reporting. But research that began in the mid-1990s hasn't revealed any cause for concern that depleted uranium fragments were causing harm to those harboring them.

"We've had some 70 people followed at the Baltimore [Veterans Affairs Medical Center] that were hit with depleted uranium," Kilpatrick said. "We've not seen any health effects in them yet."

The new registry's aim is to look at the effects of embedded metal fragments over the long term. To date, the registry has looked at 400 to 500 fragments to determine their makeup.

Those who have had fragments removed and sent to the registry but still live with unrecoverable fragments will become part of a database, Kilpatrick said. Administrators will use medical records created when servicemembers were injured in blasts and subsequent medical records to add to that database, Kilpatrick said.

This information will be shared with the Veterans Affairs health care system, because the intention of the registry is to follow the veterans for the rest of their lives, he said.

"We're really on the very ground floor of building this registry," Kilpatrick said. "As we're working with the services we're saying, 'Let's make sure that we're covering the people who are in the electronic records that are really pretty valid from about 2005 forward.'"

Earlier records, including those from the very start of the conflicts in Iraq and Afghanistan, aren't in electronic format and therefore are more difficult to use for the registry, he said.

The registry holds promise on many fronts, Kilpatrick said. It has the potential to help the military spot trends and track down potential causes of illnesses, and it could lead to new tests that would determine the type of metal and its concentration in an individual.

It also will help the military keep tabs on the enemy.

"We never know what the enemy may be shooting at us," Kilpatrick said. "We don't really know what the enemy's going to be putting in some of these roadside devices. The question is always 'What's on the world market?'"

So far, Kilpatrick said, the catalogued metal fragments don't show anything unusual.

"The good news is that we've not seen anything in those fragments that is a dangerous-type metal," he said. "These are all the usual types of metals -- iron being the most prevalent one, followed by aluminum or copper or brass. Things you'd expect to see."

The whole aim of the program, he said, is to be able to care for servicemembers properly and give them some peace of mind that the fragments they carry shouldn't cause any problems.