An unusual nail-gun injury

Life-Threatening Nail Gun Injuries

The use of pneumatic and explosive cartridge-activated nail guns is common in the construction industry. The ease and speed of nailing these tools afford enhance productivity at the cost of increased potential for traumatic injury. Although extremity injuries are most common, life-threatening injuries to the head, neck, chest, or abdomen and pelvis may occur. During a 20-month period, eight potentially life-threatening nail gun injuries were admitted to a Level I trauma center, including injuries to the brain, eye, neck, heart, lung, and femoral artery. Mechanism of injury included nail ricochet, nail gun misuse due to inadequate training, and successful suicide. Nail guns have significant potential for causing severe debilitating injury and death. These findings indicate a need for improved safety features and user education. The various types of nail guns, their ballistic potential, and techniques for operative management are discussed.

Penetrating knee injuries: the nail gun

Since the development of the nail gun in the 1950s, various reports cite injuries to the head, chest, abdomen, and extremities. Few of these reports mention any nail gun injuries to the knee joint. A total of 33 patients with penetrating injuries to the knee was identified. Of these, 13 had penetrating wounds caused by power nail guns or staplers. The average age was 25 years (range, 17-40). In 10 of the 13 patients, bone involvement (femur in 6, patella in 2, tibia in 1, and both femur and patella in 1) occurred. Treatment consisted of arthroscopy with irrigation of the knee and nail removal in 10 patients. The other 3 patients underwent arthrotomy in conjunction with nail removal and irrigation. No drains were used postoperatively. I.v. cephalosporin antibiotics were given initially in all cases and were continued orally after hospital discharge. Immediate post injury follow-up varied from a few days to 3 months. Six of the 13 patients were found for follow-up 10-33 months (average 19 months) post injury. All of these returned to full duty in the home construction industry. None developed an infection or needed additional surgery. Based on this series, power nail gun knee joint wounds should have tetanus prophylaxis, arthroscopic evaluation, and irrigation of the knee joint in conjunction with nail removal, i.v. antibiotics for 12-48 h, followed by a 10-day course of oral antibiotics. Unless cultures indicate differently, a first-generation cephalosporin is recommended.

Traumatic fixation of the hip by a bolt fired from a bolt gun

A 25-year-old building worker was struck in the left hip by a 12.7-cm long bolt fired from a bolt gun. The bolt penetrated deeply into the pelvis, through the acetabulum, the joint cavity and the head of the femur leading to fixation of the hip. In spite of immediate extraction of the nail, cleansing, immobilization, antibiotics and tetanus prophylaxis, the wound became infected. The tips of the modern types of nails used in nail guns may be coated with a plastic material which can constitute a troublesome foreign body if left behind, because the nail is merely extracted without opening and exploring the track.