title: Phoenix date palm injuries: a review of injuries from the Phoenix date palm treated at the Starship Children's Hospital.
abstract: BACKGROUND
  The purpose of this study was to review patients treated for penetrating Phoenix date palm injuries. Documentation of the clinical behaviour of these injuries was sought as they have different clinical outcomes to other foreign body injuries.
  
  
  METHODS
  Data was collected via a retrospective review of patient files and imaging studies of all patients with foreign body injury admitted to the Orthopaedic Service of Starship Children's Hospital between 1992 and 1997.
  
  
  RESULTS
  Of 250 patients admitted with foreign body injuries, 21 cases were identified as caused by the Phoenix date palm. The age range was 5 to 12 years. There was a median delay of 43 days between the time of injury and presentation to hospital. An average of 1.3 operations were performed on each patient. Ultrasound was used in 12 cases, foreign body was identified in 10 patients--a sensitivity of 83%. Intraoperative ultrasound was also found to be beneficial in three of these cases.
  
  
  CONCLUSIONS
  Phoenix date palm injuries often have a protracted course. The initial diagnosis and treatment of such injuries is often delayed. Fracturing and fragmentation of the barbs may occur and multiple surgical procedures may be required to remove all of the foreign material. The Phoenix date palm barbs may cause a severe tissue reaction with sterile granulomatous synovitis and bony pseudotumour formation. A high level of suspicion on history taking and surgical exploration is needed. Total synovectomy for delayed joint or tendon sheath involvement may be required when fragmentation has occurred. Ultrasound has higher sensitivity for detection of thorn foreign bodies than magnetic resonance imaging.
authors.affiliation: Department of Paediatric Orthopaedics, Starship Children's Hospital, Auckland, New Zealand. gaia-dr@xtra.co.nz
authors.forename: C D
authors.initials: CD
authors.lastname: Adams
authors.forename: F J
authors.initials: FJ
authors.lastname: Timms
authors.forename: M
authors.initials: M
authors.lastname: Hanlon
mesh_terms: D002648:Child; D002675:Child, Preschool; D062109:Dermatologic Surgical Procedures; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D005549:Foreign-Body Reaction / Q000209:etiology; D015745:Granuloma, Foreign-Body / Q000209:etiology; D006104:Granuloma, Plasma Cell / Q000209:etiology; D006801:Humans; D007430:Intraoperative Care; D008279:Magnetic Resonance Imaging; D008297:Male; D009520:New Zealand; D018514:Plant Structures / Q000009:adverse effects*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012867:Skin / Q000000981:diagnostic imaging / Q000293:injuries*; D000074402:Synovectomy; D013585:Synovitis / Q000209:etiology / Q000601:surgery; D013708:Tendon Injuries / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy*