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Foreign Body Migration Along a Tendon Sheath in the Lower ExtremityA Case Report and Literature Review
Gregory B. Firth, MD, FCS(Orth)(SA), MMed(Orth)(Rand)1; Anvesh Roy, MD1; Paul J. Moroz, MD, MSc, FRCS(C)1
1 Department of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada. E-mail address for P.J. Moroz: pmoroz@cheo.on.ca
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Apr 20;93(8):e38 1-5. doi: 10.2106/JBJS.J.00902
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Extract

Retained foreign bodies unintentionally migrating within the body can result in substantial morbidity1,2 and even mortality; for example, Kirschner-wire migration via blood vessels can cause cardiac damage and death3. More commonly, a penetrating foreign body in the foot, particularly a wooden object, can lead to cellulitis, osteomyelitis, or an apparent "pseudotumor."4-9 However, foreign bodies in the foot do not appear to migrate far, in contrast to those in the upper extremity, which can migrate along some distance10-12. We report a case of a toothpick penetrating a child's foot and migrating a sufficient distance to be undetectable with conventional imaging techniques. While appropriate imaging technology is available, technology alone may fail to locate foreign bodies, as we describe in the following case report. Thus, one must consider the local anatomy to identify potential migration routes of the retained foreign body.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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