A 32-year-old man presents to the emergency department for treatment of a gunshot wound above the knee on his left thigh. He reports having sustained the injury 1 hour earlier. The patient has no significant medical history and does not have additional injuries. He is able to walk despite the injury.

His vital signs are normal except for an elevated pulse (110 bpm), which improved following the administration of fentanyl, and high blood pressure (133/84 mm hg). Physical examination is normal except for an entrance wound noted on the upper outer left thigh and an exit wound noted just above the knee. Distal neurovascular examination is intact, and there is no active bleeding associated with the wound.

Complete blood count and metabolic panel are both ordered, and the results are normal. Radiographic examination of the patient’s knee is obtained (Figure).

What do these images show? What is the next best step in treatment?


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