Retained foreign bodies are fairly common in children. Entry may occur from stepping on the object or a fall. Most foreign bodies can be identified and removed without difficulty. For others, the bodies may remain for months or years, causing intermittent symptoms before removal. Nonmetallic bodies are most difficult to identify. Glass with lead content often is visible on standard radiographs. Sometimes no history of penetrating injury is given at all, and the problem may be thought to be osteomyelitis or a soft tissue infection. Most foreign bodies should be removed.
Removal in the Emergency Room
If the object can be seen or felt, it can usually be removed in the emergency room. Administer tetanus prophylaxis. Image and remove the object. If the patient is anxious or any question exists about the ease of removal, remove the object in the operating room.
Removal of Deeply Imbedded Foreign Bodies
Plan removal of deeply imbedded foreign bodies with anesthesia, adequate assistance, and good lighting. Metallic objects can be easily imaged, and fluoroscopic guidance is helpful. Objects deeply imbedded in the foot are often more difficult to remove than initially imagined.
Nonmetallic objects may be identified by ultrasound. Intraoperative imaging may be very helpful. Long delays in removal may allow considerable foreign body reactions, which may be seen radiographically, on CT or MRI scans.
The case shown at the bottom of this page is a 15-year-old girl who had chronic pain over the lateral aspect of the foot. She had several courses of antibiotics, each time followed by recurrence. An AP radiograph and CT scan demonstrated periosteal reaction of the 5th metatarsal. The MRI showed a possible foreign body. Operative exposure of the site revealed a splinter of wood. This was removed. It measured 6 cm in length.