2 weeks ago
This patient got distracted for a second, and the next thing he knows is the nail gun fired a nail right through his thumb!
Nail gun-related injuries are a serious occupational risk with potentially lethal outcomes.
The nail gun is a mechanical device used in multiple construction and home improvement applications.
Powered by either an explosive charge or compressed air, this tool generates enough force to fire a projectile up to 10 cm in length, with velocities as high as 1400 feet per second, into fully stressed concrete. This can be equated to the firing capacity of a .22 caliber handgun or rifle.
Most of these workplace injuries occur during routine use and are due to accidental discharge, careless handling of equipment, overpenetration of structures by the projectile, ricochet or shattering of the projectile, and the structural unsoundness of the receiving material.
The majority of injuries involve retained nails with trauma limited to the surrounding soft tissues.
Direct bony injuries to the digits, hand, and wrists as well as penetrating injuries to the interphalangeal and radiocarpal joints are the commonest.
Operative removal of the nail and wound care resulted in successful treatment in this case.
Conservative treatment includes nonsurgical nail extraction combined with debridement and a course of antibiotics. This treatment is often sufficient for injuries caused by small smooth nails with minimal contamination and no major structural damage. Surgical exploration and extraction—with surgical debridement and irrigation—is likely to be necessary for more complicated cases especially if symptoms or signs suggest involvement of nerves, arteries or joints. Adults who have sustained injuries deemed to be tetanus prone should receive a ADT booster, if more than 5 years have elapsed since their last dose.
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