Pediatric emergency medicine trisk 3372 3372

digits are flexed ( Fig. 110.1 ). Applying a noxious stimulus and noting inability
to withdraw the finger that is tested may show injury to the extensor tendons.
Role of Imaging. If the history or physical examination raises concern for
possible foreign material in the wound, consider obtaining a radiograph or an
ultrasound. This is especially important in assessing a wound caused by glass. A
deeply embedded piece of glass may be missed without radiographs or
ultrasound. Some recommend obtaining plain radiographs in all cases in which
glass is involved, except for the most superficial wounds. Ultrasound is more
sensitive in detecting and localizing foreign bodies and can identify those that are
nonradiopaque, such as plastic and wood, which will not be seen on plain films. It
is a good idea to further inspect for foreign material after the wound is
anesthetized, as well as counsel families that retained foreign body is a possible
complication.
Finally, bones nearby the wound should be palpated for crepitus, tenderness, or
deformity, which may suggest a fracture. Obtain radiographs to confirm
suspicious findings. Wounds overlying a fracture may constitute an open fracture
and deserve consultation with an orthopedic surgeon for possible management in
the operating room. Table 110.2 summarizes general principles of wound
assessment.