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An Unexpected Foreign Body in the KneeA Case Report
Emmanuel Gibon, MD1; Bertrand Lagrave, MD2; Allison J. Rao, BA3; Jean Matsoukis, MD2
1 Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedic Research Center, Service A, Cochin Teaching Hospital, 27 rue du Faubourg Saint Jacques, 75014 Paris, France. E-mail address: emmanuel.gibon@gmail.com
2 Department of Orthopaedic Surgery, Jacques Monod Hospital, 29 Avenue Pierre Mendès France, 76290 Montivilliers, France. E-mail address for B. Lagrave: bertrandlagrave@gmail.com. E-mail address for J. Matsoukis: jean.matsoukis@ch-havre.fr
3 Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Building R116, Stanford, CA 94305. E-mail address: ajrao@stanford.edu
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Investigation performed at Jacques Monod Hospital, Montivilliers, France

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Jun 12;3(2):e54 1-5. doi: 10.2106/JBJS.CC.L.00282
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An open fracture is usually an “in-out” injury in which the fractured bone penetrates through the soft tissue and skin, increasing the risk of contamination from skin bacteria. Conversely, the opposite mechanism can occur: an “out-in” injury is when a foreign body penetrates into the wound, thus increasing the risk of infection. With out-in injuries, the wound can become contaminated with materials such as debris, wood, or metal (e.g., from a gunshot). In a war situation or with acts of terrorism, injuries with foreign bodies are reported, especially with shrapnel. Military personnel who deal with improvised explosive devices and suicide bombers are particularly vulnerable to out-in injuries.
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