Migrating Shrapnel: A Rare Cause of Knee Synovitis

Schroeder, Josh E.; Lowe, Joseph; Chaimsky, Gershon; Liebergall, Meir; Mosheiff, Rami

doi:10.7205/milmed-d-09-00254

Cited by 5 publications

(6 citation statements)

References 11 publications

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“…However, the initial X-rays were not available for comparison. Similarly, in two patients, migration of iron fragment from the upper thigh to knee joint causing symptoms after 5 and 20 years following the initial injury was also reported [6,15]. In both patients, the metal fragments were retrieved with the aid of arthroscopy.…”

Section: Case Reports In Surgerymentioning

confidence: 88%

“…A retained shrapnel deep within the muscle tissue rarely causes problems. However, complications due to shrapnel within the joint cavity due to either initial impact or subsequent migration have been reported [2][3][4][5][6]. The majority of the previously reported cases were related to retain lead bullets within the joint cavity or the periarticular region causing synovitis and systemic lead toxicity.…”

Section: Discussionmentioning

confidence: 99%

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Retained Shrapnel from a Blast Injury as a Rare Cause of Secondary Osteoarthritis of the Hip Joint: A Case Report and Review of Literature

Basnayake

Nihaj

Pitagampalage

et al. 2019

Case Reports in Surgery

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Background. Complications related to intra-articular retained shrapnel are rare and primarily depend on the anatomical location and the reaction with the surrounding tissue. Retained bodies causing severe osteoarthritis with bone destruction and limb shortening are extremely rare. We describe a rare occurrence of retained shrapnel, possibly iron nails causing a late presentation of grade 4 secondary osteoarthritis of the hip joint with destruction of the femoral head and limb shortening. Case Presentation. A 74-year-old otherwise healthy Sri Lankan male with a history of blast injury to the right hip 35 years ago presented with an isolated, right sided mild hip pain with a progressive limp for an 8-year duration. He had a true right limb shortening of 3.6 cm and limited range of motion. However, he had minimal functional disability. An X-ray of the pelvis and hip joints showed grade 4 osteoarthritis of the right hip joint with destruction of the right femoral head. There were three retained metallic nails (shrapnel) in the right hip joint of which two were intra-articular. Although he was offered a total hip arthroplasty, he opted for conservative management due to his minimal functional disability. Modified foot wear and simple analgesics were prescribed, and he had no worsening of symptoms at 6 months of follow up. Conclusion. Late presentation due to shrapnel-induced osteoarthritis with bone destruction and limb shortening is extremely rare. Initial assessment with radiographs is essential following blast injuries to exclude intra-articular or periarticular foreign bodies. Such foreign bodies should be removed to prevent the associated local and systemic complications.

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Section: Case Reports In Surgerymentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Retained Shrapnel from a Blast Injury as a Rare Cause of Secondary Osteoarthritis of the Hip Joint: A Case Report and Review of Literature

Basnayake

Nihaj

Pitagampalage

et al. 2019

Case Reports in Surgery

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“…Although many times embedded objects can be asymptomatic and require no further management, migration of the foreign body or the formation of a fistula is possible, causing symptoms and requiring surgical intervention. 1 One case involved the formation of a purulent fistula appearing a year after an explosive wound to the lumbosacral spine, which was treated with antimicrobials. Recurrence of the fistula several times after mdedge.com/fedprac treatment led to surgical removal of the shrapnel along with antibiotic treatment of the osteomyelitis.…”

Section: Discussionmentioning

confidence: 99%

“…hrapnel injuries are commonly encountered in war zones. 1 Shrapnel injuries can remain asymptomatic or become systemic, with health effects of the retained foreign body ranging from local to systemic toxicities depending on the patient' s reaction to the chemical composition and corrosiveness of the fragments in vivo. 2 We present a case of a reactivating shrapnel injury in the form of a retroperitoneal infection and subsequent iliopsoas abscess.…”

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confidence: 99%

Catheter-Directed Retrieval of an Infected Fragment in a Vietnam War Veteran

El‐Gazzar¹

2022

Federal Practitioner

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Background: Shrapnel injuries are commonly encountered in war zones. The severity of these injuries depends on the initial damage and both the anatomical and immune response at the time of injury or at more remote times in the case of reactivation. Case Presentation: A veteran sustained a shrapnel injury to his left lower abdomen while serving in the Vietnam War. Nearly 50 years later, the patient presented with a recurrent retroperitoneal abscess associated with a residual fragment. In cooperation between interventional radiology and surgery, traditional endovascular techniques and devices were used to relocate an extravascular, secondarily infected fragment to an area more suitable for a minor surgical approach in the left inguinal region. Subsequent surgical excision and removal required only a superficial incision as opposed to a large retroperitoneal dissection, minimizing recovery time and allowing quick and full healing of the patient. Conclusions: This case demonstrates a multidisciplinary approach to transforming an otherwise large retroperitoneal dissection to a minimally invasive and technically efficient abscess drainage and foreign body retrieval.

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“…Kim [8] used microarthroscopy to extract stainless steel particles embedded in the tibial plateau. Most case reports of foreign bodies in knee joints involve a bullet; 10 such reports exist in literature [9][10][11][12][13][14][15][16][17][18]. With magnification, it is relatively easy to extract small objects with arthroscopy.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic retrieval of a large foreign body: A case report and literature review

Qin¹,

Li²,

SongCen³

et al. 2018

biomedicalresearch

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Background: We report the removal of a large metallic foreign body and review the relevant literature. Methods: A 28 y old woman was admitted with left knee swelling, pain, and limitation of activity resulting from an accident 7 d earlier. Radiography revealed a 3 × 1 cm foreign body at the mid-tibial plateau. As the foreign body may have been metallic, it was not possible to perform magnetic resonance imaging to determine whether damage to the cruciate ligaments was present. Finally, the foreign body was retrieved. Results: A 3 × 4 × 5 cm triangular broken knife blade was removed from the joint cavity. We excised the lateral meniscus, which had been damaged by the foreign body, and debrided the hyperplastic synovial membrane. Recovery was favorable with no complications. The patient was followed up at 6 months after surgery. Conclusions: While foreign bodies in the knee are not uncommon, the presence of a large object is rare. When foreign bodies are small, most can be removed arthroscopically with a minimum of difficulty. In contrast, large foreign bodies within the knee joint cavity require an incision to open the joint for adequate exposure and removal of the object. Such a procedure can result in severe complications, such as infections and joint deformities. The decision to use one or the other approach requires careful consideration regarding the condition of the patient along with the skill, knowledge, and experience of the health care team.

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Migrating Shrapnel: A Rare Cause of Knee Synovitis

Abstract: although nonsurgical treatment of shrapnel in soft tissues is the treatment of choice in many cases, late migration is possible, causing distal symptoms and may require surgical excision.

Cited by 5 publications

References 11 publications

Retained Shrapnel from a Blast Injury as a Rare Cause of Secondary Osteoarthritis of the Hip Joint: A Case Report and Review of Literature

Retained Shrapnel from a Blast Injury as a Rare Cause of Secondary Osteoarthritis of the Hip Joint: A Case Report and Review of Literature

Catheter-Directed Retrieval of an Infected Fragment in a Vietnam War Veteran

Arthroscopic retrieval of a large foreign body: A case report and literature review

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