A Case Series Analysis of Missed Foreign Bodies in the Upper Extremity Following Penetrating Traumatic Wounds: New Insights into Old Challenges

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Abstract Background: Retained foreign bodies (FBs) are uncommon, despite the higher prevalence of traumatic puncture wounds. Injuries that cause a feeling of a foreign body should be examined thoroughly. Graphite or other pigmenting elements, wooden fragments, glass, or other vegetative FB are encountered post-trauma. Persistent sensation and associated pain are indicators that a foreign body has to be removed. Objectives: The objectives of the present study were to evaluate and prompt management of patients presenting with retained FBs following penetrating traumatic wounds in the upper extremity. Materials and Methods: All the patients presenting with foreign body sensation with history of penetrating injuries were evaluated and managed promptly in the single surgical unit of a tertiary healthcare centre for a duration of one year. Results: Accurately identifying high-risk individuals with a thorough medical history and physical examination is the first step in a recommended strategy. The majority of FB are the result of trauma or accidental injury. FB is possible in any wound. The next course of action should be obtaining plain film radiographs with views in at least two anatomical planes if the patient or the practitioner has a reasonable suspicion. If the clinical examination is inconclusive and only radiopaque objects (metal, glass, or gravel) are suspected, the provider may stop here. However, an ultrasound check of the area needs to be done if radiolucent things such as thorns, wood, or plastic are detected. Depending on the degree of suspicion, the physician may decide to proceed with CT or MRI if the foreign body is still not found. Prior to removing a foreign body, radiography or ultrasonography should be used for wound exploration and early imaging. It is important to go over the advantages and risks of removal with the patient. While certain FB might be kept in situ, if there is a high risk of issues, removal should be taken into consideration, as seen in our cases for the effective management of the patients. Conclusion: Effective foreign body removal requires a patient who is cooperative and has adequate vision of the site. Sufficient analgesia combined with judicious use of sedation and anxiolytics may prove beneficial. It is advised to irrigate the wound with a stream or normal saline water following the removal of FB.