title: Toothpick injury simulating a pigmented villonodular synovialitis.
abstract: Injuries to the foot caused by foreign bodies are a frequent cause of local wounds and infections. In most cases, removal of the debris is easy and no comprehensive surgical care is needed. This case report is about a patient who stepped on a toothpick 10 years ago. The toothpick penetrated the intermetatarsal region I/II of the patient's right foot without any harm to bone or tendon. Assuming total removal of the toothpick only a partial removal was performed. Eight years after the injury a painless swelling occurred for the first time. The tumor was removed surgically. The histologic workup showed a pigmented villonodular synovitis. In the subsequent year swelling occurred again. Under the impression of recurrent pigmented villonodular synovitis a surgical revision was performed. Surprisingly, an almost completely preserved toothpick surrounded by a distinct reaction of a foreign body granuloma was found. In conclusion, foreign-body injuries, as easy as they might seem, need a careful diagnostic workup and sufficient therapy. With injuries documented in medical history, the possibility of a retained foreign body should be considered.
authors.affiliation: Department of Orthopedic Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany. bernd.wegener@med.uni-muenchen.de
authors.forename: Bernd
authors.initials: B
authors.lastname: Wegener
authors.forename: Andreas
authors.initials: A
authors.lastname: Ficklscherer
authors.forename: Peter Ernst
authors.initials: PE
authors.lastname: Müller
authors.forename: Andrea
authors.initials: A
authors.lastname: Baur-Melnyk
authors.forename: Volkmar
authors.initials: V
authors.lastname: Jansson
authors.forename: Hans Roland
authors.initials: HR
authors.lastname: Dürr
mesh_terms: D000293:Adolescent; D003937:Diagnosis, Differential; D018409:Foot Injuries / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones; D013586:Synovitis, Pigmented Villonodular / Q000175:diagnosis*