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The volkmann's spoon technique for removal of the elusive foreign body
Injury, Int. J. Care Injured 32 (2001) 516– 517 www.elsevier.com/locate/injury
Ideas and innovations
The volkmann’s spoon technique for removal of the elusive foreign body Richard Roach Department of Orthopaedics, Stafford District General Hospital, Stafford, ST16 3SA, UK Accepted 22 February 2001
The removal of a simple foreign body can be frustrating despite using a variety of techniques for example: CT stereotactics, fogarty balloon catheters or endoscopic dormia baskets [1,2]. Radiographic localisation and arthroscopic techniques have also made foreign body removal easier [3 – 5]. Soft tissue fragments generally are mobile and fortunately many can be seen on plain soft tissue radiographs and portable image intensification. The battle for removal however is a common scenario with the fragment resisting any attempts despite using all manner of instrumentation. The surgeon may approach the foreign body by touch or attempt more complex 3-dimensional needle localisation both of which may massage it further than its original track. When finally removed the offending object may leave behind it a far more extensive area of injury than it caused on the way in. This technique involves passing an appropriately sized Volkmann’s spoon under image intensification towards the fragment aiming to catch it within the scooped recess. The spoon’s shape allows it to be easily orientated (Fig. 1). Depending on the fragment’s characteristics it may be possible to then draw it out. Alternatively the spoon can be used as a clear target to dissect towards or pass forceps onto. It may even be possible to lift the spoon superficially, elevating the skin, to allow the surgeon to incise onto directly.
This technique may be less applicable for foreign bodies which have been in situ long enough to cause extensive fibrosis or if local anatomy prevents safe passage of the spoon. Care must be taken if the spoon passed via a separate track compared to the one taken by the fragment or when localising needles to avoid them being pushed further away (Fig. 2). Soft tissue destruction and surgical time can be reduced by this method and the Volkmann spoon’s technique should therefore be added to the armamentarium of surgical procedures currently in existence for removal of the elusive foreign body.
.
Fig. 1. Volkmann’s spoon angled at 0.45 and 90° with a metal staple positioned 5 mm from the recess. 0020-1383/01/$ - see front matter © 2001 Elsevier Science Ltd. All rights reserved. PII: S 0 0 2 0 - 1 3 8 3 ( 0 1 ) 0 0 0 2 6 - 2
R. Roach / Injury, Int. J. Care Injured 32 (2001) 516–517
517
Fig. 2. (a, b) AP and lateral radiographs demonstrating the localisation of a needle embedded in the lateral aspect a heel.
References [1] [2]
[3]
Blacklock JB, Maxwell RE. Stereotactic removal of a migrating ventricular catheter. Neurosurgery 1985;16(2):230 –1 Feb. Nandapalan V, McIliwain JC. Removal of nasal foreign bodies with a fogarty bilary balloon catheter. J Laryngol Otol 1994;108(9):758 – 60 Sep. Sciciliano CJ, Lefkowitz. Removal of an intraosseous metallic
[4]
[5]
foreign body in the calcaneus utilising a fluoroscopically guided bone trephine, J. Foot Ankle Surg. 1994 Jan – Feb; 33 (1): 83 – 6. Williams MS, et al. A new technique for removal of intra-articular bullet fragments from the femoral head. Bull Hosp Jt Dis 1997;56(2):107 – 10. Liedelmeyer R. The embedded broken-off needle. JACEP 1976;5(5):362 – 3 May.
Ideas and innovations
The volkmann’s spoon technique for removal of the elusive foreign body Richard Roach Department of Orthopaedics, Stafford District General Hospital, Stafford, ST16 3SA, UK Accepted 22 February 2001
The removal of a simple foreign body can be frustrating despite using a variety of techniques for example: CT stereotactics, fogarty balloon catheters or endoscopic dormia baskets [1,2]. Radiographic localisation and arthroscopic techniques have also made foreign body removal easier [3 – 5]. Soft tissue fragments generally are mobile and fortunately many can be seen on plain soft tissue radiographs and portable image intensification. The battle for removal however is a common scenario with the fragment resisting any attempts despite using all manner of instrumentation. The surgeon may approach the foreign body by touch or attempt more complex 3-dimensional needle localisation both of which may massage it further than its original track. When finally removed the offending object may leave behind it a far more extensive area of injury than it caused on the way in. This technique involves passing an appropriately sized Volkmann’s spoon under image intensification towards the fragment aiming to catch it within the scooped recess. The spoon’s shape allows it to be easily orientated (Fig. 1). Depending on the fragment’s characteristics it may be possible to then draw it out. Alternatively the spoon can be used as a clear target to dissect towards or pass forceps onto. It may even be possible to lift the spoon superficially, elevating the skin, to allow the surgeon to incise onto directly.
This technique may be less applicable for foreign bodies which have been in situ long enough to cause extensive fibrosis or if local anatomy prevents safe passage of the spoon. Care must be taken if the spoon passed via a separate track compared to the one taken by the fragment or when localising needles to avoid them being pushed further away (Fig. 2). Soft tissue destruction and surgical time can be reduced by this method and the Volkmann spoon’s technique should therefore be added to the armamentarium of surgical procedures currently in existence for removal of the elusive foreign body.
.
Fig. 1. Volkmann’s spoon angled at 0.45 and 90° with a metal staple positioned 5 mm from the recess. 0020-1383/01/$ - see front matter © 2001 Elsevier Science Ltd. All rights reserved. PII: S 0 0 2 0 - 1 3 8 3 ( 0 1 ) 0 0 0 2 6 - 2
R. Roach / Injury, Int. J. Care Injured 32 (2001) 516–517
517
Fig. 2. (a, b) AP and lateral radiographs demonstrating the localisation of a needle embedded in the lateral aspect a heel.
References [1] [2]
[3]
Blacklock JB, Maxwell RE. Stereotactic removal of a migrating ventricular catheter. Neurosurgery 1985;16(2):230 –1 Feb. Nandapalan V, McIliwain JC. Removal of nasal foreign bodies with a fogarty bilary balloon catheter. J Laryngol Otol 1994;108(9):758 – 60 Sep. Sciciliano CJ, Lefkowitz. Removal of an intraosseous metallic
[4]
[5]
foreign body in the calcaneus utilising a fluoroscopically guided bone trephine, J. Foot Ankle Surg. 1994 Jan – Feb; 33 (1): 83 – 6. Williams MS, et al. A new technique for removal of intra-articular bullet fragments from the femoral head. Bull Hosp Jt Dis 1997;56(2):107 – 10. Liedelmeyer R. The embedded broken-off needle. JACEP 1976;5(5):362 – 3 May.