Looking For The Glass In Hand

Abstract

HISTORY: An otherwise healthy 22-yo male fell on an outstretched hand shattering a glass mug he was carrying in his right (dominant) hand. He sustained multiple lacerations to the palm, and had no loss of sensation or motion of forearm, wrist, hand, and fingers. He presented urgently for wound care and to ensure there was no retained glass. PHYSICAL EXAMINATION: — Picture attached — No active bleeding — No bony tenderness to palpation — Full range of motion and muscle strength in all digits with no detectable neurovascular deficits DIFFERENTIAL DIAGNOSIS: 1. Lacerations +/-retained foreign bodies TEST AND RESULTS: Plain films of the hand- superficial 1mm x 3mm retained foreign body, proximal to the first metacarpal phalangeal joint metacarpal FINAL WORKING DIAGNOSIS: 1. Laceration with single retained foreign body TREATMENT AND OUTCOMES: 1. After failing to visualize the foreign body on exploration of wounds, an ultrasound was used to localize the foreign body. No other retained fragments were noted. 2. Ultrasound visualization allowed for real-time anatomic location and ensured complete removal of the retained foreign body - a single shard of glass. 3. Retained foreign body(ies) may inhibit wound healing and possibly cause further skin infections. Complete removal of the foreign bod(ies) would improve wound healing and decrease the likelihood of skin infections. 4. With radiographic x-rays, radio opaque foreign body(ies) may or may not be seen. 5. Moreover, radiographic x-rays and technicians may not be readily available to perform such images. 6. Lastly, radiographic x-rays emit radiation albeit minute but more so than ultrasound. 7. Ultrasounds are becoming a mainstay in primary care and sports medicine clinics.