FOREIGN GLASS

Of foreign-bodies retained after emergency treatment, more than half are glass. Features of wounds most likely to contain glass are punctures, stepping on glass, motor vehicle accidents, head or foot location[1].

Retained glass fragments may cause complications such as infection, symptomatic scarring, and injury to nerves, tendons, or blood vessels[1a,1b]

Patient perception, clinical examination and wound probing do not reliably exclude the presence of glass foreign bodies[1,2].

Glass is opaque to xrays, and fragments as small as 2 mm in diameter can be detected by plain radiographs[2a] with a reliability of up to 96%[2].

PRACTICE POINT

Failure to document wound exploration and to order radiographs are indefensible features of retained glass foreign-bodies

Diagnostic imaging is frequently omitted from the management of lacerations by broken glass: in only a third of litigated cases were radiographs ordered[3]. While radiographs will occasionally not reveal a significant glass foreign body, they should be routine when broken glass has been involved in lacerations - including to exclude multiple pieces when one or more have been removed.

Emergentologists can[4] and arguably should be routinely trained to identify glass foreign bodies using portable fluoroscopy.