Presentation
Accidental nail gun penetration through the left-hand.
Patient Data
Evidence of penetrating trauma with multiple nails present. The larger nail projects with the hypothenar /medial soft tissues with two smaller nails projecting overlying the base of the 3rd metacarpal and distal shaft of the 5th metacarpal, palmer surface. There are no post-traumatic bony abnormalities present. There is a halo surrounding the digits. There is a rectangular density projected overlying the palmer surface with all three nails penetrating the object. There is medial soft tissue swelling adjacent to the larger nail.
The photographs assist in explaining the unusual X-ray appearance of this patient with a nail gun penetrating injury. The larger nail penetrated the dorsal surface, and medial wrist, with tenting of the cut protective glove (white and yellow border) at the site of penetration. This nail projects through the wooden plank additionally. The two smaller nails were embedded within the wooden plank and non-penetrating. The red glove is the "inner" of the protective glove.
Photographs are uploaded with the patients permission.
Case Discussion
An unusual and confusing hand X-rays in a nail gun penetrating injury. In this instance, direct clinical examination of the appearance of the hand, with the partially cut protective outer and inner glove, attached wooden plank and visible penetrating nail assists in interpreting the X-rays. The mechanism of injury and the patient's explanation assists to confirm the solitary nail penetrating incident with the two smaller nails incidentally embedded in the wooden plank and non-penetrating as such. It is essential to have tangential views when assessing foreign bodies and penetrating traumatic incidents on X-rays, however in this instance even with multiple views the imaging can be confusing.
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