Ehsan Bolvardi - Department of Edalatian Emergency, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
Masoud Pezeshki Rad - Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
Bitta Abbasi - Department of Radiology, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
Reza Akhavan - Department of Edalatian Emergency, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran

Background: Detection of foreign bodies trapped in the soft tissue is a diagnostic problem in patients with penetrating traumareferring to the emergency department. In spite of increasing advances in imaging modalities, detection of foreign bodies trapped inthe subcutaneous tissue is still problematic. Among the methods available for the detection of foreign bodies, radiography is the mostaccessible modality, but it can only diagnose radiopaque objects. CT scan has some limitations including cost and radiation. MRI is veryexpensive and is not always available. Ultrasound is an easy, inexpensive and accessible method and has no radiation risk. It also providessimultaneous imaging and is bed side available and effective, especially in detection of radiolucent foreign bodies. Objectives: So the new clinical question is that: Is bedside ultrasound a reliable method for detecting soft tissue foreign bodies in upperextremity penetrating trauma patients Patients and Methods: 112 patients with penetrating trauma of volar surface of hand and wrist were enrolled in this study. All patientswere clinically suspicious of tendon injury that made them be candidates for diagnostic surgical exploration. Before the surgery, thepatients signed a consent form and then a thorough ultrasonography was performed to evaluate the presence of any foreign bodies. Theresults were then compared with the records of radiography as well as clinical reports of emergency physician and surgeon. Results: Among 112 patients under study, foreign body was detected in 21 patients through clinical examination or surgery, out of which 18(85.71%) cases were detected by ultrasonography; whereas, radiography was able to detect 16 cases (76.19%). False positive results reportedone case (1.1%) in ultrasonography and 0 (0%) in radiography. Conclusions: Ultrasonography seems to be a safe and cost effective method to evaluate foreign bodies, especially radiolucent objects, inpatients with penetrating trauma and suspicious of foreign bodies that may remain undiagnosed in radiography. Availability of bedsideultrasound for emergency physicians is an important issue, since it is not possible to access the radiologist at any time of the day andnight. On the other hand, treatment of patients in emergency department is a cost-effective way, as it reduces the number of surgicalexplorations that are merely diagnostic and it is also time and cost-consuming for therapeutic system.

Trauma; Upper Extremity; Patients