Soft tissue radiographs are required for all lacerations involving glass and any wound suspected of having a retained foreign body. Radiographs can detect glass fragments greater than 2 mm in diameter and gravel greater than 1 mm in diameter with greater than 95 percent sensitivity.3 Wood, plastic, and most organic material is radiolucent. If a radiolucent foreign body is strongly suspected, computed tomography (CT) or magnetic resonance imaging (MRI) is recommended. 4 Although ultrasound has been advocated as a method to detect radiolucent foreign bodies, this technique has not been validated in prospective clinical studies. Plain radiographs of the involved extremity should be performed when an underlying fracture is suspected.
Lacerations over joints should be examined for joint capsule integrity. Unfortunately, prediction of joint penetration on physical examination alone is incorrect up to 43 percent of the time when compared with diagnosis by injecting the joint.5 If joints are penetrated, management may change in up to 40 percent of these patients. If the depth of a wound suggests that the joint capsule could be violated, further evaluation is recommended. Plain radiographs may demonstrate air within the joint space, a clear sign of joint penetration. One also may consider injecting the joint. The skin should be cleaned with antiseptic and the joint injected with sterile normal saline (NS) through one of the standard arthrocentesis approaches at a site separate from the laceration ( I§ble,,40.:5.). Fluid leaking from the wound indicates joint penetration. For smaller joints or lacerations, a few drops of sterile fluorescein can be added to the NS and the wound inspected under a Wood's lamp after injection.
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