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Sequelae of Foreign Bodies in the Wrist and Hand
Vishnu C. Potini, MD; Ramces Francisco, MD; Benhoor Shamian, MD; Virak Tan, MD;
University of Medicine and Dentistry of New Jersey- New Jersey Medical School

Introduction: Penetrating injuries to the hand are a common occurrence in the emergency room, and embedment of foreign bodies is suspected in many of these cases. The existing literature offers little information on retained foreign bodies. The aim of this study was to identify characteristics, determine prevalence, and observe outcomes for retained foreign bodies in the wrist and hand.

Materials and Methods: Four hundred thirty-seven consecutive hand and wrist radiographs in 437 patients from the emergency department of a level 1 trauma center were reviewed for the presence of retained foreign bodies. Patient demographics, mechanism of injury, associated injuries and treatment were obtained from medical records. Location, size, number, and type of foreign body were recorded. All subsequent hospital admissions, emergency department, and outpatient visits were reviewed for complications related to the foreign body.

Results: Of the 437 cases, 65 patients (15%) had at least one retained foreign body. Nineteen of the 65 (29%) patients underwent removal of the foreign body at initial presentation, with removal performed in the emergency room for 15 patients. The average size of foreign bodies removed was 6 mm (range, 1-23mm; SD, 5mm), compared to 3 mm (range, 1-22 mm; SD, 4mm) for those left in situ, p=0.03. Forty-eight percent of the patients with glass foreign body underwent removal at time of presentation. In the 46 patients where the foreign body was left in situ, only two (4%) developed complications directly related to the retained foreign body. One of these patients underwent removal.

Conclusion: Based on our data, we only recommend removal of foreign bodies that are easily accessible, or as a part of a broader procedure to repair injured structures. Otherwise, we advocate expectant management for most patients, as only 2% of retained foreign bodies required removal at a later date.

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