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Dai ZZ, Sha L, Zhang ZM, Li H, Li H. Arthroscopic retrieval of knee foreign bodies in pediatric: a single-centre experience. INTERNATIONAL ORTHOPAEDICS 2022; 46:1591-1596. [PMID: 35471609 DOI: 10.1007/s00264-022-05410-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/15/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The present study was to investigate the clinical features of foreign body (FB) residues in children's knee joints, surgical retrieval, and postoperative function of knee joints. METHODS This retrospective study included a total of 13 children (8 boys and 5 girls; the mean age is 6.69 years old, range from 2 to 16 years old) who underwent retrieval surgery of knee FBs in our hospital. Related clinical factors were recorded and analyzed to find the influence factors of surgical methods and FBs' location change. RESULTS The FBs in 11 cases were removed completely by arthroscopy, two cases by open surgery changed from arthroscopy. Besides glass pieces (n = 4, 31%) and wooden splinter (n = 1, 7%), sewing needle fragments were the most common type of knee foreign body (n = 8, 62%). There were two patients with FBs whom open surgery changed from arthroscopy was performed. The FBs of patients with open surgery changed from arthroscopy were more likely to locate in the posterior compartment (p = 0.04), and had a higher interval between injury and surgery than that in patients with arthroscopy (p = 0.01). The location of FBs (all were needle fragments) had changed intra-operatively in three patients, whose mean weight was lower than patients with fixed FBs (p = 0.04). The FB (small glass piece) of one patient was flushed out of the joint during arthroscopy. CONCLUSION Arthroscopic retrieval surgery was an effective procedure to remove the FBs of the children's knee joint. The earlier it is detected, the easier it is to be treated. The location change of FBs should be cautioned in arthroscopic surgery and they are more likely to migrate into the posterior compartment of the knee joint.
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Affiliation(s)
- Zhen-Zhen Dai
- Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu District, 1665 Kongjiang Road, Shanghai, China
| | - Lin Sha
- Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu District, 1665 Kongjiang Road, Shanghai, China
| | - Zi-Ming Zhang
- Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu District, 1665 Kongjiang Road, Shanghai, China
| | - Hao Li
- Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu District, 1665 Kongjiang Road, Shanghai, China
| | - Hai Li
- Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yangpu District, 1665 Kongjiang Road, Shanghai, China.
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Rai S, Humagain V, Khakurel S, Marasini RP, Sherchan B. Incidental Finding of a Thorn in the Left Knee Joint of an Amateur Football Player and Arthroscopic Removal: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00027. [PMID: 34264898 DOI: 10.2106/jbjs.cc.21.00237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 19-year-old male amateur footballer was referred to our center with complaints of relapsing and remitting pain, swelling, and reduced range of motion of the left knee. History, radiological, and laboratory findings were unrevealing, except for chronic synovitis. On arthroscopy, a 3.3 × 0.3-cm thorn was found embedded in the anteromedial aspect of the anterior cruciate ligament and was carefully removed. The postoperative course was uneventful. CONCLUSION The foreign body must be considered as differential diagnoses in players presenting with unilateral chronic synovitis of the knee. Knee arthroscopy is the gold standard for both diagnostic and therapeutic purposes when the history is unclear, and radiological investigations are inconclusive.
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Affiliation(s)
- Saroj Rai
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Vaskar Humagain
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Sharad Khakurel
- Department of Anesthesia, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Rudra Prasad Marasini
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Binod Sherchan
- Department of Orthopedics and Trauma Surgery, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
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Keyes S, Morscher MA, Bono KT. Bernoulli-Assisted Percutaneous Removal of an Intra-articular Foreign Body: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00043. [PMID: 33957641 DOI: 10.2106/jbjs.cc.20.00202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 4-year-old child presented with an intra-articular broken sewing needle in her knee. It was removed arthroscopically using a spinal needle percutaneously placed posterior to the tibia in line with the long axis of the sewing needle. The stylet was partially withdrawn to allow the sewing needle to lay within the spinal needle hollow. When the stylet was removed, the foreign body was propelled through the spinal needle by the increased velocity of the outflowing fluid and decreased pressure (Bernoulli's principle) and was caught in a specimen container. CONCLUSION This percutaneous technique is one of several for removing a small foreign body.
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Affiliation(s)
- Sean Keyes
- Department of Orthopedic Surgery, AdventHealth Medical Group, Orlando, Florida
| | - Melanie A Morscher
- Department of Orthopedic Surgery, Akron Children's Hospital, Akron, Ohio
| | - Kenneth T Bono
- Department of Orthopedic Surgery, Akron Children's Hospital, Akron, Ohio
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Retained Shrapnel from a Blast Injury as a Rare Cause of Secondary Osteoarthritis of the Hip Joint: A Case Report and Review of Literature. Case Rep Surg 2020; 2019:7190781. [PMID: 31976117 PMCID: PMC6954476 DOI: 10.1155/2019/7190781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/21/2019] [Indexed: 11/18/2022] Open
Abstract
Background Complications related to intra-articular retained shrapnel are rare and primarily depend on the anatomical location and the reaction with the surrounding tissue. Retained bodies causing severe osteoarthritis with bone destruction and limb shortening are extremely rare. We describe a rare occurrence of retained shrapnel, possibly iron nails causing a late presentation of grade 4 secondary osteoarthritis of the hip joint with destruction of the femoral head and limb shortening. Case Presentation A 74-year-old otherwise healthy Sri Lankan male with a history of blast injury to the right hip 35 years ago presented with an isolated, right sided mild hip pain with a progressive limp for an 8-year duration. He had a true right limb shortening of 3.6 cm and limited range of motion. However, he had minimal functional disability. An X-ray of the pelvis and hip joints showed grade 4 osteoarthritis of the right hip joint with destruction of the right femoral head. There were three retained metallic nails (shrapnel) in the right hip joint of which two were intra-articular. Although he was offered a total hip arthroplasty, he opted for conservative management due to his minimal functional disability. Modified foot wear and simple analgesics were prescribed, and he had no worsening of symptoms at 6 months of follow up. Conclusion Late presentation due to shrapnel-induced osteoarthritis with bone destruction and limb shortening is extremely rare. Initial assessment with radiographs is essential following blast injuries to exclude intra-articular or periarticular foreign bodies. Such foreign bodies should be removed to prevent the associated local and systemic complications.
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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.
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Affiliation(s)
- Anil Agarwal
- Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India,Address for correspondence: Dr. Anil Agarwal, 4/103, East End Apartments, Mayur Vihar Phase 1 Extension, New Delhi - 110 096, India. E-mail:
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Manifestation der Lyme-Arthritis am Kniegelenk. ARTHROSKOPIE 2014. [DOI: 10.1007/s00142-014-0823-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Vaiman M, Lazarovich T, Lotan G. Pantoea agglomerans as an indicator of a foreign body of plant origin in cases of wound infection. J Wound Care 2013; 22:182, 184-5. [PMID: 23702670 DOI: 10.12968/jowc.2013.22.4.182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the role of Pantoea agglomerans as an infectious agent that causes infection in a wound even after the wound was managed at the emergency department. METHOD A retrospective cohort study, reviewing the medical records of patients with traumatic wounds that were admitted to the emergency department from 2007-20 12 and had signs of wound infection for more than I 0 days after the wound was managed. Bacteriological results, clinical picture,and treatment results were obtained. RESULTS Nine cases were identified. Pantoea agglomerans was detected in all cases. After 1-2 months of ineffective treatment, patients were hospitalised and surgical revisions of the wounds were performed.In all cases, small foreign bodies of plant origin were detected. After surgical revision, wounds were healed in 2-3 days. CONCLUSION In cases of prolonged healing of post-traumatic wounds, the presence of foreign bodies of plant origin infected with Pantoea agglomerans should be taken into account. Removal of such foreign bodies leads to rapid healing of the wounds.
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Affiliation(s)
- M Vaiman
- Department of ENT, Head and Neck Surgery, Tel AvivUniversity, Israel. vaimed@yahoo_com
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Oestern S, Varoga D, Trompetter R, Lippross S, Klüter T, Weuster M, Schröder O, Seekamp A. [Knee joint infections]. Unfallchirurg 2013; 116:255-68; quiz 269-70. [PMID: 23478901 DOI: 10.1007/s00113-012-2325-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Knee joint infection represents an emergency case at every age. Joint infection occurs frequently after trauma or joint surgery. The infection can be caused by numerous bacteria, viruses, or yeasts; however, Staphylococcus aureus is identified as the cause in 85-95 % of joint infections. Early treatment is important for patient outcome. In addition to synovectomy and therapeutic arthroscopy, antibiotic therapy is essential and should be started after sample recovery.
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Affiliation(s)
- S Oestern
- Abteilung für Unfallchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 7, 24105 Kiel.
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[Etiology and classification of septic coxitis]. Unfallchirurg 2012; 115:967-71. [PMID: 23097133 DOI: 10.1007/s00113-012-2202-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Septic coxitis is a rare disesase which can be caused by a variety of pathogens. Primary and secondary coxitis can be differentiated depending on the etiology. In the initial stages the diagnosis is difficult but a delay in making the correct diagnosis or delayed therapy can result in fatal consequences for the patient, therefore, therapy should be started even in cases of suspected septic coxitis. Septic coxitis is classified into four stages depending on the arthroscopic findings. The best results are usually achieved by a combination of arthroscopic lavage and antibiotic therapy.
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Abstract
The authors report a case of a 7-year-old boy who sustained a penetrating injury of a splinter of wood to the knee. Arthroscopic examination, removal of visualised foreign material and washout did not alleviate the symptoms of pain and swelling in its entirety. Microbiology cultures also failed to determine the cause of the on-going symptoms. Five days later, the patient underwent a mini arthrotomy through a lateral incision, which demonstrated synovitis, and removal of the remaining embedded foreign body from the lateral condyle. Although the authors advocate arthroscopy as the surgeon's first choice for removal of a foreign body from the knee, a mini-arthrotomy should also be considered to facilitate superior visualisation and easier instrumentation to remove embedded foreign bodies.
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Affiliation(s)
- Rachel Louise O'Connell
- Department of Trauma and Orthopaedics, Ashford and St Peter's NHS Foundation Trust, Surrey, UK.
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Duerinckx JFH. Case report: subacute synovitis of the knee after a rose thorn injury: unusual clinical picture. Clin Orthop Relat Res 2008; 466:3138-42. [PMID: 18773251 PMCID: PMC2628235 DOI: 10.1007/s11999-008-0482-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Accepted: 08/13/2008] [Indexed: 01/31/2023]
Abstract
Synovitis secondary to penetrating plant thorn injuries is not frequently reported. Historically, it is considered aseptic and treated with removal of the intraarticular foreign body and affected synovial lining. We report a 57-year-old healthy man who was admitted 2 weeks after being injured by a rose (Rosacea) thorn with subacute and mild synovitis with effusion of his right knee. No intraarticular foreign body was retained. Pantoea agglomerans was identified in the synovial fluid. Contrary to former teaching, effusions from joints violated by thorns should not be presumed sterile. Bacterial growth is reported infrequently, but when reported, Pantoea agglomerans is the most common organism found. We recommend removal of foreign bodies if present, arthroscopic total synovectomy, and beginning empiric antibiotic treatment with coverage against gram-negative enteric pathogens in all cases of thorn synovitis until the results of culture specimens are known. Improved physician awareness can result in more rapid diagnosis and improved clinical outcome in affected individuals.
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Affiliation(s)
- Joris F. H. Duerinckx
- Department of Orthopaedic Surgery, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
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Abstract
The differential diagnosis for monoarticular arthritis is extensive. Patient omissions from the history can compound this broad diagnostic dilemma. A case report is presented of a 32-year-old female with an eight-month history of isolated right first metatarsophalangeal joint (MTPJ) pain, after exhaustive, non-specific diagnostic evaluation. An open biopsy was performed, and a 3.5 cm wooden foreign body, believed to be the result of an injury 18 years prior, was excised from the 1st MTP. Open biopsy may be required as an important part of the workup for definitive diagnosis of a foreign body synovitis. A discussion regarding the presentation, clinical and diagnostic findings follows.
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Affiliation(s)
- Kenneth S Bode
- Department of Orthopaedics, Wilford Hall Medical Center, San Antonio, TX, USA.
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Oztekin HH, Aslan C, Ulusal AE, Sertoz SZ, Ustaoglu RG, Fowler J. Arthroscopic retrieval of sewing needle fragments from the knees of 3 children. Am J Emerg Med 2006; 24:506-8. [PMID: 16787818 DOI: 10.1016/j.ajem.2005.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Accepted: 12/08/2005] [Indexed: 11/30/2022] Open
Abstract
Penetrating knee joint injuries are less common in children than adults. Foreign bodies that penetrate into the knee joint often mimic septic arthritis and synovitis. In the management of such cases, rheumatological tests, medical imaging, and finally arthroscopy are essential. We present 3 children who presented to our ED with broken sewing needles (home-use variety) in their knee joints. By history, these incidents occurred while playing indoors. Clinical findings were similar to those of acute septic arthritis. Patients were treated successfully by arthroscopic surgery and were symptom-free at follow-up several months later.
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Affiliation(s)
- Haluk H Oztekin
- 2nd Department of Orthopaedics and Traumatology, Atatürk Research and Training Hospital, Izmir, Turkey.
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