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Tips and tricks in the diagnostic workup and the removal of foreign bodies in extremities.

OBJECTIVE
The aim of this study was to analyze the diagnostic and therapeutic challenges during the removal of foreign bodies in extremities, and to provide relevant tips and tricks.


METHODS
The medical records of 295 patients (150 men, 145 women; mean 26.82 ± 16.84 years; range: 3 to 79 years) who underwent foreign body removal from their limbs between February 2005 and July 2011, were retrospectively reviewed. Side of the extremity, foreign body type, location, complaints, imaging technique, the season of injury, the effects of foreign body in the body, the time between injury and extraction, indication for extraction, type of anesthesia, the use of fluoroscopy during the surgical procedure, and complications of surgical intervention were analyzed.


RESULTS
The injury was in the right limb in 157 patients and in the left limb in 138 patients. Foreign bodies were in the elbow in 4 cases, in the forearm in 6, in the wrist in 6, in the hand in 75, in the hip in 1, in the thigh in 7, around the knee joint in 11, in the knee joint in 6, in the lower leg in 10, in the ankle in 8, and in the foot sole in 161. The season of injury was summer in 148 cases, winter in 107, spring in 35, and autumn in 5. The removed foreign bodies were needles in 216 cases, metallic objects in 33, pieces of glasses in 28, pieces of wood in 10, pieces of plastic in 4, and pieces of stone in 4. The time between the injury and foreign body removal was 1 day in 135 cases, 2 to 10 days in 114, 11 to 30 days in 22, and 30 to 365 days in 13. The removal time was longer than 1 year such in 11 cases.


CONCLUSION
Foreign body injuries may result in serious complications such as infection, migration and joint stiffness. A throughout history and physical and radiological examinations are of tremendous importance to achieve the best outcome in these patients.