digits are flexed ( Fig 110.1 ) Applying a noxious stimulus and noting inability to withdraw the finger that is tested may show injury to the extensor tendons Role of Imaging If the history or physical examination raises concern for possible foreign material in the wound, consider obtaining a radiograph or an ultrasound This is especially important in assessing a wound caused by glass A deeply embedded piece of glass may be missed without radiographs or ultrasound Some recommend obtaining plain radiographs in all cases in which glass is involved, except for the most superficial wounds Ultrasound is more sensitive in detecting and localizing foreign bodies and can identify those that are nonradiopaque, such as plastic and wood, which will not be seen on plain films It is a good idea to further inspect for foreign material after the wound is anesthetized, as well as counsel families that retained foreign body is a possible complication Finally, bones nearby the wound should be palpated for crepitus, tenderness, or deformity, which may suggest a fracture Obtain radiographs to confirm suspicious findings Wounds overlying a fracture may constitute an open fracture and deserve consultation with an orthopedic surgeon for possible management in the operating room Table 110.2 summarizes general principles of wound assessment