Abstract
Puncture wounds in children are very common and often result in foreign body retention.
Organic materials in the form of plant thorns present problems in identification and
localization because they are not visualized with plain radiographs. A case of a 10-year-old
girl with a small piece of retained hawthorn is presented. Correct diagnosis and treatment
were delayed because of misinterpretation of magnetic resonance image studies. Ultrasound
ultimately located the foreign body, and assisted in its excision. Plant thorns may
be toxic and produce an intense local inflammatory response. In the case described
in this article, deep infection caused by Enterobacter cloacae and Pantoea agglomerans was associated with the retained thorn. The small size of the foreign body, misinterpretation
of diagnostic images, and the deep infection highlight the challenges that can be
encountered by physicians managing puncture wounds in children.
Level of Clinical Evidence
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Ankle extensor tendon synovitis due to a date palm thorn.Foot Ankle. 1989; 10: 180-183
- [Plant thorn synovitis in a child.].Ugeskr Laeger. 1992; 154: 347-348
- Plant thorn synovitis.Arthritis Rheum. 1977; 20: 1125-1128
- Plant thorn tenosynovitis.J Clin Rheumatol. 2006; 12: 137-138
- Chronic synovitis caused by a date palm thorn: an unusual clinical picture.Arthroscopy. 2002; 18: E7
- Distal migration of a foreign body (sago palm thorn fragment) within the long-finger flexor tendon sheath.Am J Orthop. 2008; 37: 208-209
- Pseudotumours due to oil palm thorn injury.Aust N Z J Surg. 1977; 47: 223-225
- Plant thorn granuloma.J Mil Med. 1995; 160: 39
- Thorn-induced granuloma of the medial cuneiform.J Foot Surg. 1992; 31: 247-249
- Injuries from palm tree thorn simulating tumoral or pseudotumoral bone lesions.Acta Orthop Belg. 2001; 67: 279-282
- Cactus thorn arthritis: case report and review of the literature.Clin Rheumatol. 2000; 19: 490-491
- Monarthritis of the pediatric knee joint: differential diagnosis after a thorn injury.Arthroscopy. 2004; 20: 865-868
- [The incidence of poisoning by Karwinskia humboldtiana in Mexico.].Salud Publica Mex. 1995; 37: 57-62
- Buckthorn neuropathy in vitro: evidence for a primary neuronal effect.J Neuropathol Exp Neurol. 1982; 41: 204-220
- [Geographical factors in the epidemiology of intoxication with Karwinskia (tullidora) in Mexico.].Cad Saude Publica. 2000; 16: 255-260
- Intoxication with buckthorn (Karwinskia humboldtiana): report of three siblings.Pediatr Dev Pathol. 2007; 10: 66-68
- Case report: subacute synovitis of the knee after a rose thorn injury: unusual clinical picture.Clin Orthop Relat Res. 2008; 466: 3138-3142
- Isolation of fungi from rose bush thorns.J Okla State Med Assoc. 2000; 93: 271-274
- Candida parapsilosis infection in a rose thorn wound.J Am Board Fam Pract. 1995; 8: 484-485
- Isolation of Pantoea agglomerans in two cases of septic monoarthritis after plant thorn and wood sliver injuries.J Clin Microbiol. 2000; 38: 460-461
- Pantoea agglomerans as a cause of septic arthritis after palm tree thorn injury: case report and literature review.Arch Dis Child. 2003; 88: 542-544
- Plant thorn synovitis: an uncommon cause of monoarthritis.Semin Arthritis Rheum. 1991; 21: 40-46
- Thorn-induced periostitis associated with Enterobacter agglomerans infection.Can Med Assoc J. 1978; 119: 925-928
- Prolonged cellulitis due to plant thorn.Turk J Pediatr. 2005; 47: 393-396
- Thorn synovitis: CT diagnosis.J Comput Assist Tomogr. 1985; 9: 1135-1136
- Preoperative localization of a foreign body by magnetic resonance imaging.Eur J Radiol. 1998; 26: 309-311
- Plant thorn synovitis diagnosed by magnetic resonance imaging.Scand J Rheumatol. 1994; 23: 154-155
- Detection of a 0.5-mm-thick thorn using ultrasound: a case report.J Hand Surg Am. 1995; 20: 456-457
- Diagnosis of plant-thorn synovitis by a high-resolution ultrasonography: a case report and literature review.Clin Rheumatol. 2007; 26: 849-851
- The role of ultrasonography in detection and localization of radiolucent foreign body in soft tissues of extremities.JNMA J Nepal Med Assoc. 2009; 48: 5-9
- Imaging of plant-thorn synovitis.Skeletal Radiol. 2000; 29: 605-608
- Palm thorn synovitis.J Pediatr Orthop. 1984; 4: 175-179
- Plant thorn synovitis. Resolution following total synovectomy.J Bone Joint Surg Br. 1990; 72: 514-515
- Date palm thorn synovitis.J Bone Joint Surg Br. 1990; 72: 512-513
Article info
Publication history
Published online: December 04, 2009
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.