This too shall pass: A study of ingested sharp foreign bodies.

BACKGROUND: Gastrointestinal foreign body (GFB) ingestion is a common problem and often results in surgical consultation. Current literature is limited to case reports and fails to provide data regarding the management of sharp GFB ingestion. We hypothesized that patients who ingest sharp objects rarely have perforation or obstruction requiring surgical intervention. METHODS: Patients presenting with GFBs from January 2005 to December 2015 at a level 1 trauma center with an acute care surgery program were retrospectively reviewed. Exclusion criteria were leaving without being seen, noningested GFB, unknown or blunt GFB, or if the GFB was not found on imaging. Data collected included patient demographics, length of stay, imaging, and interventions that were performed. RESULTS: During the study period, there were 1,164 patients with 1,245 hospital visits for GFBs; 995 visits were excluded, resulting in 169 sharp GFB ingestion patients with 192 visits included in our study. The average age was 31. Sixty-five percent were men, and 41% were incarcerated. The average length of stay was 3 days, which was longer in patients with psychiatric holds and consultations. Of the 169 patients, 116 (69%) had no intervention and did not return for complications. Fifty-five endoscopies were performed with GFB removal in 30 cases. Seven patients (4%) underwent surgery, five of which had peritonitis. When evaluating the total study cohort, 134 (79%) of the patients had no procedure or a negative procedure. Patients requiring surgery had significantly larger objects (6 ± 3 cm) than those who had endoscopy (3 ± 2 cm) or no procedure (2 ± 1 cm). CONCLUSION: Surgical intervention occurred in only seven (4%) patients with sharp GFB ingestions, and 79% of the patients required no intervention. Barring an acute abdomen or esophageal sharp GFBs, patients can be discharged with return precautions, admitted for necessary psychiatric care, or returned to custody for patients seeking secondary gain. Upper gastrointestinal larger GFBs should be removed endoscopically when possible. LEVEL OF EVIDENCE: Therapeutic/care management study, level V.

An evaluation of halo pin insertion torque on outer table penetration in elderly patients.

STUDY DESIGN: An experimental anatomic study performed on elderly cadaveric skulls. OBJECTIVES: (1) To determine the pin penetration depths in outer table of skull at different torques in the elderly population during halo pin insertion and (2) to validate a safe range of torque for use in this population. SUMMARY OF BACKGROUND DATA: The elderly are at an increased risk of falls, which can lead to cervical fractures. The halo pins used to stabilize these injuries present unique problems in this population owing to osteoporosis, and intracranial pin penetration should always be avoided. METHODS: A halo ring was used to insert pins in 4 standard positions on 10 elderly cadaveric skulls. Incremental torques were used to drive the pin into the outer table, and the penetration of each pin was measured using computed tomography imaging at each stage. RESULTS: Eight to Twelve in-lb of torque was not sufficient to fully penetrate the outer table of the skull. Only at 16 in-lb of torque was the outer table penetrated, and only anterolaterally, hence the posterolateral outer table is more resistant to penetration than the anterolateral outer table. CONCLUSIONS: Despite age-related bone changes in the elderly, it is still safe to use 8 in-lb of torque when inserting pins for a halo vest. However, as the anterolateral outer table is weaker than the posterolateral outer table, a new pin design with broader shoulders should be used anterolaterally to ensure maximal patient safety.