International Journal of Research in Orthopaedics | March-April 2019 | Vol 5 | Issue 2 Page 359 International Journal of Research in Orthopaedics Filip F et al. Int J Res Orthop. 2019 Mar;5(2):359-361 http://www.ijoro.org Case Report A rare case of metallic foreign body in the knee of a 16 year old boy Florin Filip 1 *, Adrian Tataranu 2 , Violeta Stefan 3 INTRODUCTION Injuries at the knee level are frequent in the emergency room (ER) practice and can be associated with foreign body retention. 1,2 Surgery is the only curative treatment in these patients. We present the case of a 16 year old boy who accidentally inflicted himself a penetrating wound with retention of a metal screw at the left knee level. Diagnosis was made by history, visualization of the foreign body and plain X-ray films. Removal of the foreign body by open surgery was performed after admission. The final outcome was good, with no signs of infection and rapid restoration of local movements. CASE REPORT A 16 year old boy presented in ER with acute left knee pain and stiffnes lasting for a few hours. He related that, while drilling screws into the floor of his house with a pneumatic device, he accidentally inflicted himself a knee wound. A metal screw was shot by mistake into his left knee, resulting in acute pain and local stiff knee flexion. Otherwise he had no previous medical history, nor he related any kind of allergies. The physical exam (PE) revealed a healthy young boy in acute distress because of local pain, with the left knee bent in a stiff 90° flexion position. The entrance level of the foreign body (metal screw) was easily identified on the anterior side of the left knee (Figure 1). He had normal neuro- vascular status of the left foot. The rest of the PE was unremarkable. Posterior-anterior (PA) and lateral views of the left knee were taken in ER-they revealed the location and the size of the foreign body (Figure 2 a and b). The screw was penetrating the medial femoral condyle and entered the knee joint. The patient received acetaminophen 1 g iv and cefuroxime 1 g iv, after which he was admitted in our department. Tetanus boost was also administered. Because he was complaining of acute pain and there was a high risk of infection or local damage to the left knee, surgery was performed shortly after admission. After the patient received spinal anesthesia, he was placed on the operating table with the left knee in a 90° flexion using a pillow as support. We performed local debridement of the wound, mechanical extraction of the metallic screw from the left knee (Figure 3) and copious lavage of the area. Cefuroxime 1 g iv q 12 hours and clindamycine 600 mg iv q 8 hours were given postoperatively for 24 hours. The postoperative course was unremarkable, with no fever and pain controlled with p.o. medication. The patient ABSTRACT Foreign bodies at the knee level are related to local trauma with subsequent retention. Removal of the foreign body is curative. We present the case of a 16 year old boy with a foreign body (metallic screw) inside the left knee joint related to an unusual home accident. The outcome was favorable after removal of the foreign body and appropriate antibiotic coverage. Keywords: Knee, Foreign body, Metallic screw, Surgery 1 Department of Pediatric Surgery and Orthopedics, 2 Department of Radiology, 3 Department of Anesthesiology, Emergency County Hospital, Suceava, Romania Received: 05 January 2019 Accepted: 05 February 2019 *Correspondence: Dr. Florin Filip, E-mail: ffilip_99@yahoo.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20190806