An Unexpected Foreign Body in the Knee: A Case Report.

Abstract

An open fracture is usually an “in-out” injury in which the fractured bone penetrates through the soft tissue and skin, increasing the risk of contamination from skin bacteria. Conversely, the opposite mechanism can occur: an “out-in” injury is when a foreign body penetrates into the wound, thus increasing the risk of infection. With out-in injuries, the wound can become contaminated with materials such as debris, wood, or metal (e.g., from a gunshot). In a war situation or with acts of terrorism, injuries with foreign bodies are reported, especially with shrapnel. Military personnel who deal with improvised explosive devices and suicide bombers are particularly vulnerable to out-in injuries. One of the major difficulties with penetrating foreign bodies is the identification of the foreign material on radiographs1. One unexpected foreign body is foreign human bone. Although more likely to occur with a military trauma, such a situation can also occur with high-energy civilian injuries. This situation is extremely rare, and, to the best of our knowledge, only five cases previously have been reported. These include foreign bone that was found in a nonfractured wrist2, a nonfractured shoulder3, a nonfractured knee4, the thorax5, and the neck6. In all of these cases, physicians were challenged with the difficult task of preoperatively identifying the foreign body and determining how to manage the bone loss and risk of infection. We present an extraordinary case of an accident involving two men. Each patient had a fracture of the left knee; one of the patients had a penetrating injury from a foreign bone fragment. The patients were informed that data concerning their cases would be submitted for publication, and they both provided consent. Patient 1, a forty-five-year-old man, and patient 2, a twenty-nine-year-old man, were participants …