Foreign Body-Related Extremity Trauma in Children: A Single-Center Experience

Abstract

The extremity foreign body in a child has propensity of getting missed or mistaken diagnosis. We report our experience of extremity foreign body trauma in order to increase awareness of this disease entity. The retrospective series of 24 retained foreign bodies was based on a 10-year chart review of emergency data (ICD code Z18). Patients with both upper and lower limb affections were included. Patients with ocular, otolaryngeal, tracheobronchial, gastrointestinal, and axial foreign bodies were excluded from the study. Male predominance (M:F = 20:4), young patient age (mean 6.8 years), variable lag period for consultation (range 3 h-8 years), and majority lower limb affection (58%; foot [7; 29%] and knee [5; 20.8%]) were some characteristics of extremity foreign bodies trauma. The foreign bodies reported were metallic needle (7; 29%), rubber band (3; 12.5%), pellets (3; 12.5%), bangle glass (2; 8%), glass pieces (2; 8%) "dhaga," wooden twig, wooden thorn, ceramic earthen pot pieces, stapler pin, broomstick, and cracker piece in one case each (1; 4%). Postremoval, the wound healing was uneventful in all patients. Foreign body-related extremity trauma in children is a rare event. It has its own set of characteristics and differential diagnosis. Familiarity with the regional practices and customs is must to establish the circumstances/nature of the foreign body injury. The foreign body should preferably be removed in a well-equipped setting.

Keywords: Child; Pediatrics; extremities; foreign bodies; foreign body; pediatric.

Figure 1

(a) Clinical photograph showing discharging sinus (b) X-ray of distal thigh with knee joint anteroposterior and lateral views showing no bony changes (c) Extracted wooden twig. (d) Magnetic resonance imaging of knee joint: T2W images are particularly helpful in these cases with nonmetallic foreign bodies

Figure 2

(a) Clinical photograph showing palpable pellets in the right hand of a 3-year-old child. The child suffered from weak grip (b) Plain radiographs of hand anteroposterior and oblique views showing pellets (c) Extracted pellets

Figure 3

(a) Clinical photograph showing the most common metallic foreign body-metallic sewing needle. In this particular case, the thread was the telltale sign. (b) Plain radiographs of foot anteroposterior and oblique views showing metallic foreign body - sewing needle. (c) Extracted needle

Figure 4

(a) Clinical photograph showing characteristic circumferential scar over wrist region usually indicates the forgotten “dhaga” or rubber band (b) In this case, part of rubber band was seen emerging from the wound clinching the diagnosis

Figure 5

(a) Clinical photograph showing another common foreign body seen in Indian region – glass bangle. (b) Plain radiographs of hand anteroposterior view showing the glass which is usually opaque. Concomitant periosteal reaction of 3^rd metacarpal is also obvious. (c) Extracted foreign body

Figure 6

(a) Clinical photograph showing the extremity trauma due to an uncommon foreign body – fire cracker plastic projector. (b) Plain radiographs of thigh with knee joint anteroposterior and oblique views were diagnostic of the plastic material which was opaque. (c) Extracted foreign body