Soft tissue foreign body

Background

Clinical Features

Differential Diagnosis

Evaluation
  • 2013 study showed imaging study sensitivity and specificity for various types of foreign bodies (fresh wood, dry wood, glass, precelain, plastic)[1]
    • XR Sn 29%, Sp 100%
    • CT Sn 63%, Sp 98%
    • MRI Sn 58%, Sp 100%
  • In other studies, US detected and localized foreign body better than CT[2][3]

Management
  • antibiotics indicated for organic matter
  • do not extend hand wounds in ED

Indications for Removal
  • Potential for inflammation or infection
    • Vegetative or chemically reactive material
    • Heavy bacterial contamination (e.g. teeth, soil)
    • Proximity to fractured bone
    • Established infection
    • Allergic reaction
  • Toxicity
    • Spines with venom
    • Heavy metals
  • Functional and cosmetic problems
    • Impingement on nerves, vessels, tendons
    • Restriction of joint mobility
    • Proximity to tendons
    • Impairment of gait
    • Persistent pain
    • Cosmetic deformity (e.g., tattooing)
    • Psychological distress
  • Potential for later injury
    • Intra-articular location
    • Intravascular location
    • Migration toward important structures

Dispoition
  • Ortho 1-2 days if not retrievable

See Also

References
  1. Pattamapaspong N, Srisuwan T, Sivasomboon C, Nasuto M, Suwannahoy P, Settakorn J, Kraisarin J, Guglielmi G. Accuracy of radiography, computed tomography and magnetic resonance imaging in diagnosing foreign bodies in the foot.
  2. Aras MH, Miloglu O, Barutcugil C, Kantarci M, Ozcan E, Harorli A. Comparison of the sensitivity for detecting foreign bodies among conventional plain radiography, computed tomography and ultrasonography. Dentomaxillofac Radiol. 2010 Feb;39(2):72-8.
  3. Karabay N. US findings in traumatic wrist and hand injuries. Diagn Interv Radiol. 2013 Jul-Aug;19(4):320-5.
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