Radiograph shows a metal dense foreign body in 4th proximal phalanx. History of penetrating injury was asked again. Now she remembered penetrating injury to foot by a metal pin like substance; about 18 years ago.
USG was requested for two questions :
- To check whether the foreign body is partly outside bone or not.
- Approach for incision - planter / dorsal when exploration is done.
USG: shows tenosynovitis without tendon tear. Defect is noted in planter cortex of base of 4th proximal phalanx. Deep to defect there is reverberation artifact by metal - similar to anchor artifact in postoperative shoulder. A Doppler artifact is present at that point.
Surgically removed.