Retained Foreign Bodies of the Hand: Diagnosis and Surgical Removal – Two Clinical Cases
Introduction
Foreign body injuries of the hand are common, particularly in people involved in occupations such as welding, construction, carpentry and manual work. A small penetrating injury may initially appear insignificant, but a retained foreign body can cause persistent pain, localized tenderness, swelling, restricted movement and sometimes secondary infection or granuloma formation.
A careful history and physical examination are important, but the foreign body may not always be visible externally. Plain radiography is particularly useful for radiopaque foreign bodies such as metal and many types of glass.
This artical presents two cases of retained foreign bodies in the hand that were localized radiographically and subsequently removed surgically under local anaesthesia.
Case 1: Retained Metallic Foreign Body in the Hand of a Welder
Clinical Presentation
A 51-year-old male, working as a welder, presented with pain in the left hand for approximately one month. The pain was aggravated by movement and local touch.
He gave a history of a previous puncture injury with a metallic object. The patient had attempted to remove the foreign material himself at home, but symptoms persisted.
On examination, there was:
Mild localized thickening/swelling at the affected site
Local tenderness
Pain aggravated by movement and pressure
No obvious foreign body visible externally
Because of the occupational history and persistent focal symptoms following a penetrating injury, a retained foreign body was suspected.
Radiographic Evaluation
An X-ray of the hand in AP and lateral views was obtained.
The radiographs demonstrated a radiopaque metallic foreign body within the soft tissues of the affected finger/hand, confirming the clinical suspicion of a retained foreign body.
Surgical Removal
After radiographic localization, removal of the foreign body was planned.
The procedure was performed under local anaesthesia and appropriate aseptic precautions.
Following adequate anaesthesia, a small surgical incision was made over the suspected location using a No. 11 surgical blade.
Careful exploration of the wound was performed and the metallic foreign body was identified.
The foreign body was then removed completely.
Foreign Body Retrieved
The removed metallic fragment was preserved and photographed after extraction.
Follow-up
The wound was dressed following the procedure, and the patient was followed up for wound care.
The subsequent dressing image demonstrates satisfactory local healing without an obvious retained foreign body or significant local complication at the time of follow-up.
Case 2: Retained Glass Foreign Body in the Index Finger
Clinical Presentation
A 32-year-old female presented with pain and swelling of the left index finger.
She reported a history of penetrating trauma with a sharp piece of glass approximately one year earlier.
Because of the persistent symptoms and history of penetrating trauma, a retained foreign body was suspected.
On examination, there was localized tenderness and swelling around the affected region of the index finger.
Radiographic Evaluation
An X-ray of the affected finger was obtained.
The radiograph demonstrated a radiopaque foreign body within the soft tissues of the finger, consistent with the retained glass fragment based on the clinical history.
Surgical Removal of the Glass Foreign Body
After appropriate preparation and administration of local anaesthesia, the procedure was performed under aseptic precautions.
A small surgical incision was made using a No. 11 surgical blade, followed by careful exploration of the affected area.
The retained foreign body was identified and removed.
The wound was subsequently cleaned and dressed.
Pre- and Post-Procedure Imaging
Before procedure | After procedure |
 |  |
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Foreign body visible within soft tissues | Foreign body no longer visualized |
Why Can a Small Foreign Body Cause Persistent Pain?
A retained foreign body may produce symptoms through several mechanisms:
1. Mechanical irritation
A foreign body located near a tendon, joint or nerve can cause pain with movement or pressure.
2. Local inflammatory reaction
The body may mount an inflammatory response around the retained material.
3. Foreign-body granuloma
Long-standing retained material can occasionally produce a localized granulomatous reaction.
4. Secondary infection
A penetrating injury can introduce bacteria into deeper tissues, particularly when the foreign body remains in place.
5. Tendon or neurovascular irritation
Foreign bodies located near important structures of the hand require particular attention because even a small fragment can potentially affect tendon function, sensation or vascular structures.
Role of X-ray in Suspected Hand Foreign Bodies
Plain radiography remains a very useful first-line investigation when a retained metallic or radiopaque foreign body is suspected.
Two orthogonal views, usually AP and lateral, can help establish:
Presence of a foreign body
Approximate location
Relationship to adjacent bones
Whether there are multiple fragments
Associated bony injury
However, not every foreign material is equally visible on X-ray.
Metal is usually readily radiopaque, while the visibility of glass depends on its composition, size and location. Some materials such as wood and certain plastics may be difficult to detect on plain radiographs, and additional imaging such as ultrasound may be helpful when clinical suspicion remains high despite negative X-rays.
When Should a Retained Foreign Body Be Removed?
Removal should be considered when a foreign body is:
Causing persistent pain or tenderness
Producing functional symptoms
Associated with inflammation or infection
Easily accessible and safely removable
Located near a tendon, joint or neurovascular structure where it may cause complications
Associated with a significant foreign-body reaction
On the other hand, a deeply embedded, asymptomatic foreign body may sometimes be left in place if attempted removal carries greater risk than observation.
The decision should therefore be individualized according to the material, location, symptoms and relationship to important anatomical structures.
Take-Home Messages
A small penetrating injury should not always be considered trivial when pain persists.
Persistent focal tenderness after penetrating trauma should raise suspicion of a retained foreign body.
Occupational history can provide an important clue, particularly in workers exposed to metal fragments.
Plain radiography is a simple and effective method for detecting many metallic and glass foreign bodies.
Obtaining two orthogonal views can assist in localization.
Removal should be planned after considering the foreign body's location and its relationship to tendons, nerves, vessels and joints.
Follow-up is important to assess wound healing and resolution of symptoms.
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