Letter to Editor for Foreign Body-Related Extremity Trauma in Children: A Single-Center Experience.

Sir,

We read the recently published article in Indian Journal of Orthopaedics1 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.234

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:

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

The author has hardly discussed any bony lesions in his study. On the contrary, we found many bony lesions in our studies.23 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.23 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

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

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 cases2

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

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