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Year : 2019  |  Volume : 53  |  Issue : 1  |  Page : 213
Letter to Editor for foreign body-related extremity trauma in children: A single-center experience

Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India

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Date of Web Publication6-Feb-2019

How to cite this article:
Vaishya R, Vaish A. Letter to Editor for foreign body-related extremity trauma in children: A single-center experience. Indian J Orthop 2019;53:213

How to cite this URL:
Vaishya R, Vaish A. Letter to Editor for foreign body-related extremity trauma in children: A single-center experience. Indian J Orthop [serial online] 2019 [cited 2019 Aug 20];53:213. Available from:

We read the recently published article in Indian Journal of Orthopaedics[1] with keen interest. The author needs compliments for sharing their pediatric case series of a variety of presentations due to several different types of foreign bodies. However, we are surprised that the author has missed citing articles on thorn prick, the most extensive published series on acacia thorn injuries of 22 cases.[2],[3],[4]

However, we wanted to differ with the author on some points and add some more knowledge to the present topic of discussion on foreign body-induced lesions of the extremities:

  1. We disagree with the author that the foreign body injuries are rare in children. We had nine (40.9%) school-going children out of 22 cases of our series.[2] We believe that the children are more vulnerable to these injuries than the adults and moreover cannot explain their symptoms clearly to the parents or treating clinician. Several factors are responsible for high incidence of these injuries in India because of the practice of barefoot walking, our customs, and spread of sharp items in the domestic environment
  2. The author has hardly discussed any bony lesions in his study. On the contrary, we found many bony lesions in our studies.[2],[3] Foreign body-induced lesions may present both as soft tissue or bony lesions. The bony lesions may either be osteolytic or osteoblastic or a combination of both.[2],[3] In our experience, the retained foreign bodies induce inflammation in the soft tissues or bone, which may be infective or noninfective inflammation. A combination of foreign body irritation, secondary infection, or chemical irritation by the alkaloids in thorns may be responsible for these lesions.[3] These bony lesions often mimic either as infective lesions (e.g., osteomyelitis) or as a tumor due to the nature of their bone reaction
  3. The radiopaque foreign bodies (such as needles, nails, and blades) can be diagnosed easily by plain radiographs, but the radiolucent foreign bodies (such as thorns, wooden splinter, rubber, and cotton thread) are usually difficult to diagnose radiologically. In these cases, ultrasonography or magnetic resonance imaging may be helpful in the diagnosis
  4. We agree that awareness and high index of suspicion are required by the treating clinician about the possibility of the foreign body-induced lesions being crucial, to reach to a prompt diagnosis. Any unusual case presenting with a swelling, discharge, or abnormal radiograph, etc., without any explainable reason must be considered to have a foreign body-induced lesion until proved otherwise. Hence, an adequate history-taking is of paramount importance. Hence, the late presentation is a norm in these cases[2]
  5. We agree that complete surgical removal of the retained foreign body is essential for an early resolution of the symptoms and cure. What may appear to be a minor injury can produce distressing morbidity in these patients.[2]

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Conflicts of interest

There are no conflicts of interest.

   References Top

Agarwal A. Foreign body-related extremity trauma in children: A single-center experience. Indian J Orthop 2018;52:481-8.  Back to cited text no. 1
[PUBMED]  [Full text]  
Vaishya R. A thorny problem: The diagnosis and treatment of acacia thorn injuries. Injury 1990;21:97-100.  Back to cited text no. 2
Middha VP, Vaishya R. Lesions produced by splinters of wood in soft tissues and bone. Int Orthop 1990;14:47-8.  Back to cited text no. 3
Khanna V, Vaishya R, Ghuse I, Virani N. Beware of a nail prick injury with a rubber sole shoe wear. Apollo Med 2015;12:227-8.  Back to cited text no. 4

Correspondence Address:
Prof. Raju Vaishya
Indraprastha Apollo Hospitals, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ortho.IJOrtho_466_18

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