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An unusual foreign body
* For correspondence: drsuvendumaji@rediffmail.com
This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.
A 37 year old man presented to the Emergency department of Seth Sukhlal Karnani Memorial Hospital (SSKM) hospital, Kolkata, India, on December 12, 2012, with foreign body impalement of his left lower limb. The man fell over the rotating blades of power tiller machine while ploughing in the field. Four sharp blades penetrated through and through at four different places. After initial resuscitation he was taken to operation theatre where under general anaesthesia each blade was taken out by rotating the entire machine in counterclockwise fashion. The blades pierced through his upper thigh, knee joint, calf muscles and shattered his ankle joint (Figs 1, 2). The wounds were debrided and the ankle joint was stabilized with K wire (Fig. 3). Surprisingly, there was no major vascular injury apart from avulsion of posterior tibial neurovascular bundle. Postoperatively wound infection ensued and all attempts to salvage the externally stabilized foot failed. He underwent two serial amputations and weeklong conservative treatment. Post-operative investigations showed fracture of patella (Fig. 4) for which the patient was managed accordingly. Later patient was discharged in stable condition and on follow up for 16 months he continued to be in good state of health with an application of artificial limb prosthesis (Fig. 5). Penetrating injuries with rods, arrows, sharp objects are common, however, simultaneous perforation of a limb with the four blades of a power tiller is unusual.
- Three sharp blades perforating the upper thigh, knee joint and upper part of leg and calf muscle when viewed from side.
- Patient in the operating room, with the blades seen perforating through the knee and the calf muscle along with twigs and grass roots entangled with the machine.
- Postoperative x-ray (Lateral) taken in supine posture to show the foot in POP cast with K wire in situ.
- CT scan showing fracture patellae in different cuts.
- Patient post rehabilitation standing comfortably following application of lower limb prosthesis.
