Features of toothpick puncture injuries:
(1) It usually occurs when a person is walking barefoot in the home.
(2) It can be very difficult to remove all of the wooden fragments.
(3) It can be very difficult to locate residual fragments if the tissue becomes inflamed or edematous. Each attempt at probing can result in additional soft tissue injury.
(4) The injuries can become infected and may contain oral, environmental or cutaneous pathogens.
(5) Osteomyelitis may develop if an infected focus is near a bone.
Imaging studies:
(1) X-rays are insensitive for locating residual fragments since the fragments are nonmetalic.
(2) Ultrasound is useful for identifying fragments shortly after injury.
(3) If ultrasound is negative then a CT scan can often localize the fragment(s).
(4) MRI may be useful for chronic injuries where other imaging modalities have failed.
