Intra-articular Foreign Body Research Articles

A Retrospective Study of Ballistic Pelvic Fractures With Focus on Short-Term Clinical Outcomes.

To evaluate the orthopaedic management, associated injuries, and outcomes in patients treated for low-velocity ballistic pelvic fractures. Retrospective chart review. Single, urban, Level I trauma center. Patients 15 years or older treated for low-velocity ballistic pelvic (OTA/AO 61 and 62) fractures from May 2018 to August 2021. Primary study measures included pelvic fracture location, concomitant associated injuries, surgical interventions, and antibiotic treatment. Postinjury sequelae evaluated include infection, neurologic deficit, and need for orthopaedic removal of foreign body. Risk factors of postinjury sequelae were investigated. A total of 156 patients with ballistic pelvic fractures were included. The cohort consisted of 135 (86.5%) male patients with a mean age of 29.8 years. One hundred ten (70.5%) patients sustained 2 or more gunshot wounds. Ninety-eight (62.8%) patients underwent an exploratory laparotomy with 79 (50.6%) having a confirmed concomitant intestinal injury. Additional associated injuries included nerve injury (13.5%), vascular injury requiring repair or embolization (10.9%), and bladder injury (10.3%). Nine (5.7%) patients underwent orthopaedic operative management-five (3.2%) patients for operative fixation and 4 (2.5%) patients for removal of intra-articular foreign bodies. Diabetes (odds ratio [OR]: 33.1, P = 0.025), neurologic deficit on presentation (OR: 525.2, P < 0.001), vascular injury requiring repair or embolization (OR: 8.7, P = 0.033), and orthopaedic pelvic fixation (OR: 163.5, P = 0.004) were positively associated with the defined postinjury sequelae at 30 and 90 days of follow-up. There was not a statistically significant association between infection and retained foreign body (OR: 3.95 [95% CI 0.3-58.7, P = 0.318]) or bowel contamination (OR: 6.91 [95% CI 0.4-58.7, P = 0.178]). Ballistic fractures of the pelvis and acetabulum rarely required operative fixation (3.2%) or irrigation and debridement. Neither retained foreign body nor presumed bowel contamination of pelvic fractures had a statistically significant association with infection, which further supports conservative management of these injuries. Patients with diabetes, neurologic deficit on presentation, vascular injury necessitating intervention, and orthopaedic fixation of pelvic fracture are associated with increased risk of postinjury sequelae. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The value of arthroscopy in joint fractures of the lower limb

Introduction: Lower extremity joint fractures are common and require precise management to avoid complications. Arthroscopy offers advantages in terms of precise control, detection of associated lesions and minimally invasive surgery, thus improving post-operative outcomes. Material and methods: The retrospective study focused on 51 cases of joint fractures of the lower limb treated by arthroscopy at the Ibn Rochd University Hospital over a period of four years including : 30 ankle fractures, 20 knee fractures and a single case of hip joint fracture. The pathological study was carried out on a radiological analysis and the fractures were then classified according to the appropriate classification. Results: In the first case, a 16-year-old adolescent victim of a road accident suffered a postero-superior dislocation of the left hip, requiring emergency reduction followed by arthroscopy to remove three intra-articular foreign bodies. For the second case, knee joint fractures were observed in adults aged 20 to 55 years, mainly men, following road accidents. Surgical treatment included fracture reduction and internal fixation, with satisfactory postoperative results. Finally, in the third case, ankle joint fractures were observed in young and active adults, with a male predominance. Surgical treatment, carried out on average four days after the accident, also consisted of reduction of the fractures followed by osteosynthesis. Postoperative results were very positive, with rapid functional recovery and no complications reported. Discussion: Joint fractures of the lower limb include those of the hip, tibial plateaus and ankle. For hip fractures, more common in young adults, reduction of dislocations is crucial, often carried out under general anesthesia. Tibial plateau fractures, observed mainly in young men, require precise detection of associated lesions, which are often difficult to identify initially. As for ankle fractures, common in active adults, precise imaging, such as CT, is recommended to guide treatment, including arthroscopic screw fixation in cases of syndesmosis damage. Conclusion: Joint fractures of the lower limb are complex and require careful evaluation. Arthroscopy has revolutionized their treatment by providing precise assessment, direct reduction and treatment of associated lesions allowing rapid recovery and reduced post-operative risks compared to conventional surgery.

Minimally invasive removal of intra-articular hip fragments under navigation guidance

The interposition of foreign bodies between the femoral head and the acetabulum represents a danger to the articular cartilage with a definite progression to osteoarthritis. Their removal is necessary and usually involves two surgical techniques: by open arthrotomy or under arthroscopy. The present article proposes a new surgical technique allowing the removal of intra-articular foreign bodies from the hip by a minimally invasive approach and aCT-guided navigation system. This technique is a good alternative that overcomes some shortcomings of other minimally invasive techniques, which struggle to access the fragment. It can also avoid specific complications of these procedures, such as the risk of abdominal compartment syndrome with arthroscopy, in the case of an associated acetabulum fracture.

Status of Hip Arthroscopy in India: A Short Questionnaire Based Survey and Review of Literature.

Hip arthroscopy is a minimally invasive technology for diagnostic and therapeutic interventions invarious hip disorders. Over the past decade or so, the technology and understanding related to this surgery have improved by leaps and bounds; however, in India the overall pace has been limited. The present review highlights the status of hip arthroscopy in the Indian context. A small survey with five questions related to practice of hip arthroscopy among Indian orthopaedic surgeons was conducted. Additionally a PubMed database search was conducted to recognise and assess studies pertaining to hip arthroscopy originating from India. Forty-two responses were received for the questionnaire, out of which 38 surgeons performed hip arthroscopy in their practice; the overall numbers were very low with only one respondent performing more than 50 surgeries in a year. For 84.2% of the respondents, the practice was limited to less than ten surgeries per year. 63.2% of the surgeons affirmed that there has been no change in their practiceof hip arthroscopies over the past 5years, signifying the slow growth and limited application of the technique. Only nine studies pertaining to the topic were availablein the literature search, out of which five were case reports. The most common indication was removal of intraarticular foreign bodies,followed by joint debridement and lavage, synovial biopsies and femoroacetabular impingement (FAI). The outcomes in all the studies were satisfactory. Hip arthroscopy is in its nascent stages in India and much is still needed to be done for better implementation of the technique on a wider scale. Adequate training and continued medical education programme, with exposure to the experts in the field, will go a long way in better utilisation of the surgery in India.

Arthroscopic Removal of an Intra-Articular Migrating Plant Awn Associated with Septic Shoulder Joint Arthritis in a Dog

Abstract Objective The aim of this study was to describe the clinical presentation, advanced imaging findings and outcomes of arthroscopic treatment of a bacterial septic shoulder arthritis caused by the penetration of a migrating plant awn in a dog. Case Report A 10-month-old, 11 kg, sexually intact male Cocker Spaniel was diagnosed with septic arthritis of the right scapulohumeral joint. Computed tomography revealed marked articular effusion and thickening of the capsule of the right shoulder joint. Ultrasound of the shoulder identified a bilinear hyperechoic structure located within the joint consistent with a plant (grass) awn. Arthroscopy was used for foreign body removal. Antibiotic treatment was prescribed according to bacteriologic sensitivity tests. Treatment was successful: the dog completely recovered and under high levels of activity showed neither clinical signs nor recurrence of lameness on follow-up at 6 and 24 weeks after surgery. Conclusion Migrating plant awn can be the cause of septic arthritis in a dog. The combination of advanced imaging techniques and arthroscopy allowed accurate diagnosis, reduced the risk of surgical complications and shortened recovery time in this patient. Considering the benefits of minimally invasive techniques, arthroscopy represents an excellent option for the treatment of dogs with similar intra-articular foreign bodies.

Evaluation of arthroscopic skills with a virtual reality simulator in first-year orthopaedic residents.

This study of residents' initial performance was performed to determine which factors predisposed residents for success in demonstrating the best arthroscopic skills. Each orthopaedic first-year resident was officially invited to take part in a one hour evaluation on a VirtaMed™ ArthroS™ simulator. On the FAST module, the Periscoping exercise was chosen to test for use of angled optics. The Shoulder Module was chosen to test their ability to extract intra-articular foreign bodies using the Catch the Stars exercise. The variables such as time, camera alignment, camera path length, and grasper path length were analysed. Residents completed a questionnaire prior to the evaluation. Their results were analysed according to gender, orientation assessment, and surgical history. A total of 34 women and 82 men were included in the study. In the Periscoping exercise, a significant difference between women and men in the time variables was noticed (275 ± 82 and 195 ± 71; p < 0.00001) and camera path length (207 ± 60 and 170 ± 66; p = 0.00094). For the Catch the Stars exercise, there was a significant difference between women and men for the time values (249 ± 114 and 201 ± 99; p = 0.01246) and grasper path length (290 ± 130 and 229 ± 108; p = 0.00493). After multivariate analysis, no influence of self-assessed spatial perception (p=0.1), number of arthroscopic procedures (p=0.39), or laparoscopic procedures (p=0.43) to which they had already assisted was found. This study shows a significant difference in skills regarding spatial recognition and triangulation related to gender at the beginning of specialization training. It also demonstrates that male medical students are more attracted by surgical departments during their medical training.

A Novel Technique to Remove Posterior Intra-Articular Bodies Within the Hip Through an Anterior Approach

Removal of foreign and loose bodies form the hip joint classically involves arthroscopic approaches or surgical dislocation of the hip. However, traumatic injuries associated with loose or foreign bodies are often best treated via an anterior approach. Retrieving intra-articular foreign bodies through an anterior approach can be challenging even for the most experienced surgeon. We describe 2 cases of hip intra-articular foreign body removal through an anterior approach utilizing a Satinsky vascular clamp under fluoroscopic guidance.

Intra Capsular but Extra Synovial Foreign Body in the Knee Joint

Intra-articular foreign bodies especially in the knee joint are well reported. Knee joint is commonly involved due to the large joint area and also due to it being a superficial joint. Foreign bodies enter the joint either by direct inoculation or migration from nearby tissues. Potential complications of intra articular foreign bodies include infection, damage to articular surface and locking of joint. This is a report on a penetrating injury to the knee resulting in an intra capsular but extra synovial foreign body.

Foreign Body Reaction Associated With Artificial LARS Ligaments: A Retrieval Study.

Background:Artificial ligaments have been developed and used in the treatment of ligamentous injuries since the 1970s. The early generation of artificial ligaments showed promising short-term results but resulted in high rates of rupture and inflammatory reaction in the surrounding tissues.Purpose:To determine whether the use of Ligament Augmentation and Reconstruction System (LARS) ligaments is associated with the development of intra-articular foreign body reaction.Study Design:Case series; Level of evidence, 4.Methods:LARS ligaments were explanted from 15 patients under 6 consultant orthopaedic surgeons at 8 surgical centers. Of these, 14 explanted samples were sent for macroscopic and histological analysis, with the 1 remaining sample sent for scanning electron microscopy, to assess for inflammatory change as well as the degree of fibrous tissue ingrowth.Results:We observed a foreign body reaction in 10 of 14 explanted LARS ligaments. Seven samples demonstrated fibrous tissue ingrowth, with 5 producing only focal or incomplete ingrowth. The 2 samples with extensive fibrous coverage were completely free of any foreign body reaction, while all 5 remaining samples with only focal or partial fibrous ingrowth were associated with at least some degree of harmful immune response.Conclusion:The LARS ligament is still associated with a clinically significant degree of foreign body reaction despite the LARS Company’s efforts to reduce complications through improved design. The development and completion of fibrous tissue ingrowth may work to reduce the occurrence of a foreign body reaction.

MONOARTICULAR SYNOVITIS OF KNEE DUE TO UNRECOGNISED INTRA-ARTICULAR PLANT SPLINTER

AbstractSynovitis of a knee secondary to penetrating splinter injuries of plant origin aren't frequently reported. Historically, it is considered aseptic and treated with removal of the intraarticular foreign body and affected synovial lining.We report a case of a 59-year-old healthy man whose left knee was injured while at work at a bamboo plantation site. He presented to us with pain and swelling of the knee for one month. He underwent diagnostic arthroscopy of the knee wherein a foreign body was identified, located and removed and near total synovectomy was done.We present this patient's case and its management with a review of the relevant literature.

Acetabular fracture: Long-term follow-up and factors associated with secondary implantation of total hip arthroplasty

The present study sought to determine long-term outcome in acetabular fracture and the factors associated with secondary implantation of a total hip arthroplasty and/or with poor functional results. Seventy-two patients admitted between 2000 and 2005 were followed up for a maximum 11 years (mean, 6.8 years): 16 females, 56 males; mean age at injury, 41.6 years (median, 40 years). There were 45 simple acetabular fractures, 27 complex fractures and 27 dislocations. Late complications were: osteoarthritis (n=29), osteonecrosis of the femoral head (ONFH: n=8) and heterotopic ossification (n=2). Twenty-five total hip arthroplasties (THA) were performed, with a mean time to surgery of 3.7 years. Associated factors for THA were: VAS (P<0.0001), PMA (P<0.0001), osteoarthritis (P<0.0001), ONFH (P<0.0002), initial dislocation (P=0.0002), no functional treatment (P=0.0014), surgical treatment (P=0.0065), initial traction (P=0.0068), anterior and posterior congruency defect (P=0.0072 and P<0.0001), and initial intra-articular foreign body (P=0.045). Factors associated with poor or bad functional results were the same, plus: etiology (P=0.0021), BMI (P=0.03) and posterior wall fracture (P=0.0325). 4; retrospective study.

Magnetic resonance arthrography of the hip: technique and spectrum of findings in younger patients.

Magnetic resonance(MR) imaging is the reference imaging technique in the evaluation of hip abnormalities. However, in some pathological conditions—such as lesions of the labrum, cartilaginous lesions, femoroacetabular impingement, intra-articular foreign bodies, or in the pre-operative work-up of developmental dysplasia of the hip—intra-articular injection of a contrast medium is required to obtain a precise diagnosis. This article reviews the technical aspects, contraindications, normal appearance and potential pitfalls of MR arthrography, and illustrates the radiological appearance of commonly encountered conditions.

Arthroscopic removal of a plastic soft drink bottle cap in the knee: a case report

We report a rare case of late knee locking after an open knee injury in a polytrauma patient with a pelvic fracture and a contralateral femoral artery injury. Once the life and limb threatening injuries were addressed, debridement and washout of the knee wound was performed. X-rays and subsequent CT revealed only an undisplaced patella fracture. The patient presented 6 months later to a knee surgeon with recurrent locking. An arthroscopy was performed and a 10 mm plastic soft drink bottle cap was retrieved leading to the immediate resolution of symptoms without complications.Open knee injuries require thorough debridement washout and joint assessment. Late locking should raise the suspicion of an intra-articular loose or foreign body. Arthroscopy is an excellent first line tool in the diagnosis and late management of this unusual problem.

Persistierende Schmerzen nach offener Artikulosynovektomie am Kniegelenk – die vergessene Kompresse

We report about a 44-year-old woman who presented at our Orthopaedic Department suffering from persisting pain and a tumor of the right knee after open articulosynovectomy. MRI did not clarify the entity at all. The X-ray examination could identify an inlying compress after a synovectomy in 1999. The intra-articular foreign body could be removed by open revision surgery.

Subacute Synovitis of the Knee After a Rose Thorn Injury: Unusual Clinical Picture

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.

Arthroscopic evaluation of a painful prosthetic knee joint

Dear Editor, We have read with great interest the article of Jerosch and Aldawoudy [3]. We agree with these authors that stiffness following total knee arthroplasty is a disabling problem and we also agree the arthroscopical release which they have successfully performed. Multipurpose arthroscopical approaches have been described in the treatment of prosthetized knee complications. According to Kruger et al. [7], the arthroscopic approach may be indicated in patients affected by painful dysfunction of the knee joint following total joint replacement such as arthrofibrosis, impacted soft tissue, patellar malalignment, synovialitis, and intra-articular foreign bodies. Kim et al. [6] reported a successful arthroscopic removal of extruded cement fragments in unicompartmental knee prosthesis. Jerosch and Schroder [4] reported several good outcomes after resection of intra-articular plicae or fibrous nodules by means of electric cautery, meniscus punch, scissors or a motorized shaver as pathologic tissue caused persistent pain or intolerance to the mechanical derangement. In another article, Jerosch et al. [5] declare that in case of suspected knee infection, revision arthroscopy to save the prosthesis is most promising in very early postoperative infection. Recently, the author (Salvi) has carried out an arthroscopic revision of a rotating hinged right knee prosthesis (Fig. 1) of a 74-year-old female patient operated on in another hospital, affected with pain on weight bearing due to a suspected infection. Previously admitted on May 2007 for the same reason, the patient showed a purulent secretion from the superior third of the right leg and was treated only with oral antibiotics (Teicoplanin and Levofloxacin) with good outcome. On November 2007, the right knee presented a fistula on its anterior side. Tc-99 m scintigraphy showed periprosthetic areas of focal hyperactivity of both knee compartments and of the fistula with an additional small area of marked granulocytes (Fig. 2). Nevertheless, laboratory examinations did not suggest a manifest infection (white blood cells = 7.5, C-reactive protein = 12.7, erithrosedimentation rate = 120, negative coltural exam for bacteria). However, no test is 100% sensitive and 100% specific [8]. Instead of an open revision procedure, considering the presence of patellar thinning that may lead to a catastrophic disruption of the extensor mechanism [2] and considering the positive experience of some authors with synoviectomy and debridement, and continuous irrigation without implant removal [9], at the end of November 2007 it was decided for an arthroscopic examination of the prosthetized knee. In the meanwhile antibiotic treatment (Teicoplanin and Levofloxacin) was administered. The arthroscopic portals used were the anterolateral and anteromedial ones. As reported by Court A. E. Salvi Orthopaedics and Traumatology Department, Mellino Mellini Hospital Trust, Civil Hospital of Iseo, Brescia, Italy

Arthropathy caused by a lead bullet in a dog

A 3-year-old spayed female Labrador Retriever was evaluated for progressive lameness of the left forelimb 21 months after being shot in the elbow with a lead bullet. Physical examination findings were consistent with moderate osteoarthritis of the left elbow joint. Orthogonal radiographic views of the elbow revealed multiple metallic fragments in and around the joint space as well as signs of osteoarthritis. The elbow joint was evaluated arthroscopically. A lead-based bullet fragment was seen in the lateral synovial compartment and removed in multiple pieces. Excess fibrin and synovium were removed, and microfractures were created in exposed subchondral bone to stimulate neovascularization and fibrocartilage formation. In a follow-up telephone conversation 4 months after surgery, the owner reported a marked improvement in the lameness. Removal of lead intra-articular foreign bodies may be indicated even if the material is not believed to mechanically interfere with joint motion.

Radio-opaque marker of a surgical sponge appearing as an intra-articular foreign body after total hip arthroplasty

We report a 73-year-old female patient who underwent total hip arthroplasty for osteoarthritis of the right hip. An anteroposterior radiograph obtained 1 week after surgery showed an intra-articular striated foreign body. This was subsequently removed and found to be a radio-opaque marker of a surgical sponge that had been used during the operation. The patient made an uneventful recovery. In recent years, cases of retained surgical sponge after surgery have been reported occasionally. Counting surgical sponges and using sponges with radio-opaque markers are methods for preventing them from being accidentally left in situ. However, to our knowledge, there has been no report of retention of a surgical sponge radio-opaque marker at the operation site, appearing as a foreign body on an X-ray film.

Prise en charge de la synovite villonodulaire hémopigmentée du genou et de ses récidives: À partir d’une série rétrospective de 28 cas

Purpose of the study The objective of this retrospective study was to analyze clinical observations in pigmented villonodular synovitis (PVNS) of the knee as well as response to treatment in order to better define the diagnostic approach and surgical treatment and follow-up of this rare benign proliferative disease of the synovial observed primarily in the knee joint. Material and methods Twenty-eight patients (13 men and 15 women) were treated for PVNS in our unit between 1996 and 2004. Twenty patients had diffuse disease and eight localized disease. In the localized forms, symptoms mimicked those provoked by intra-articular foreign bodies or meniscal tears (n = 6) and had been present for 14 months on average at first consultation. Mean age at treatment onset was 40 years (range 20-62). Arthroscopic or open surgery was used for resection. In the diffuse forms, symptoms had begun 15 months on average before first consultation and were mainly spontaneous hemarthrosis or diffuse non-specific knee pain. Mean age at treatment onset was 38 years (range 15-59). Bone lesions were observed in four patients. Synoviorthesis or surgical synovectomy were performed. Mean follow-up was 97 months (range 12-309). Outcome was compared between the different aspects of localized and diffuse PVNS and treatment modalities. Results In the localized forms, there were no complications after surgical treatment and there were no cases of recurrence (one surgical revision at four months following incomplete resection). For the diffuse forms, the cumulative recurrence rate was 50%. Mean time to recurrence was 37 months. Three patients developed a stiff knee after open synovectomy. Surgical treatment was required in four patients seen late after development of bony lesions (total knee arthroplasty in three). Clinical outcome was good with a gain in knee flexion. Discussion MRI is essential for the topographic diagnosis and to guide surgical treatment. In severe or advanced primary diffuse di-sease or in the event of local recurrence, adjuvant synoviorthesis can be proposed four to eight weeks after initial surgery. The risk of recurrence for diffuse forms warrants an annual MRI for the first four years.

A unique case report of a tooth as a foreign body in a knee joint

A 21-year-old female rear seat car passenger wasadmitted to the emergency department withextensive facial injuries and a laceration overher left knee. The mechanism of injury involvedthe car hitting a pole. She was found by the road-side outside the car and was assumed not to haveworn a seatbelt.Onprimarysurvey,shewasnotedtobeconsciousbut confused, haemodynamically stable andbreathing spontaneously. On secondary survey,she was noted to have loose upper incisors andabsent left upper canine and incisor. She also hada cut to the lower lip. A computed tomography(CT) scan confirmed an absent left upper canineand incisor with fractures of the anterior and pos-terior maxillary walls and pterygoid fossa consis-tent with blunt trauma. A CTscan of the abdomenconfirmed a tooth in the stomach (Fig. 1a), leavingoneabsenttoothunaccountedfor.Shewasnotedtohave a 1 cm laceration over the anteromedialaspect of her left knee with intra-articular exten-sion. A radiograph of the knee confirmed air withinthe knee joint and an intra-articular foreign body(Fig. 1b).The knee was explored in the operating suiteunder a general anaesthetic and tourniquet usinga lateral arthrotomy. A tooth was found in thelateral recess of the knee consistent with the leftuppercaninethatwasabsent.Thekneewaswashedout and the lateral arthrotomy and lacerationclosed. A course of cephazolin and metronidazolewas prescribed for 5 days postoperatively. Thepatient made an uneventful recovery.