The nail gun: injuries to the knee and chest

Non-operative Management of an Accidental Knee Intra-articular Nail

Nail gun injuries are relatively common presentations to the emergency department. The majority of these injuries occur to the hands and rarely result in long-term morbidity. However, despite the large number of cases each year, little research is available regarding the optimum emergency management of nails that implant intra-articularly. Initial studies suggested that cases of nails penetrating intra-articular or neurovascular structures warranted operative debridement; however, newer studies have suggested cautious nail removal, wound debridement, irrigation, antibiotic coverage, and tetanus prophylaxis are equivalent to operative intervention for the management of most intra-articular nails. We present a gentleman in his 40s with accidental penetration of a nail fired from a nail gun into his right knee. He was neurovascularly intact. After initial evaluation and management, he was transported to a higher level of care for operative management. However, the nail was ultimately removed bedside utilizing adequate anesthesia.

Understanding Nail Gun Injuries in Orthopedics: Mechanisms and Treatment

Nail gun injuries are common among users, and most frequently involve the hands and lower extremities. A wide variation in costs and time are missed from work due to these injuries, and training on the proper use of nail guns has been shown to decrease workplace-related injuries. Minimal long-term disability can be expected, and orthopedic evaluations provide an opportunity to inform patients on proper use of these devices. In this article, management of nail gun injuries is discussed, including the necessity for a high suspicion for wound contamination because foreign material is often deposited with the nail, as well as treatment with debridement and antibiotics. [Orthopedics. 2019; 42(5):e410-e414.].

Intraoral approach for surgical removal of a nail in penetrating maxillofacial injury

An unusual case of penetrating maxillofacial injury caused by a nail gun is presented. In this case, the foreign body was shot into the left infratemporal fossa and maxillary sinus through the left cheek. We used an intraoral approach that allowed precise localization of the point of the infratemporal surface of the maxilla through which the nail penetrated the maxillary sinus. The nail was successfully removed and the patient was discharged with complete recovery. The details of the surgical approach as well as localization techniques are described. Different approaches to remove the nail as well as the advantages and disadvantages of each approach are discussed.

Review of 88 nail gun injuries to the extremities

BACKGROUND

Nail guns have been employed since 1959 to speed construction work, but with the increased productivity came an increasing number of injuries associated with the device. The majority of reported cases occur to the extremities.

METHODS

Our study retrospectively examines 88 cases of nail gun injuries to the extremities collected from a 4-year period. Radiographs and charts were used to collect data on anatomic site, type of treatment, type and duration of antibiotic treatment, and outcomes.

RESULTS

We found that infections associated with nail gun injuries were relatively rare (n=3) and in our study were limited to those patients who presented later than the day of injury. The majority of injuries were to the hand and knee (38.6% and 28.1%, respectively). No significant vascular or neurological injuries were encountered.

CONCLUSIONS

It appears that simple emergency room removal of the nail with local debridement and a short course of antibiotics is appropriate in most cases. The exception to this is where there is intra-articular or neurovascular involvement, then operative debridement is recommended.

Penetrating craniocerebral injury caused by a pneumatic nail gun: an unsuccessful attempt of suicide

Nail guns are powerful tools commonly used in the building industry. As a result of their improper use, many accidents of bodily injury, including death, have already been reported over the last 50 years; their use in suicide attempts, however, is rare. In this paper, an unusual case of unsuccessful suicidal craniocerebral penetrating injury committed with a pneumatic nail gun by a 23-year-old man is presented. The particular findings that suggest a suicidal attempt are also discussed.