Nail gun injury to thumb

Case contributed by Frank Gaillard
Diagnosis certain

Presentation

Worker on construction site.

X-ray thumb

x-ray

Nail foreign body is seen to obliquely traverse the tuft of the distal phalanx with deformity of the adjacent soft tissues, but no clear fracture. 

Post removal

x-ray

No fracture identified. This confirms the nail was adjacent to the terminal phalanx. 

Case Discussion

This simple case illustrates an important principle. Just because two views have been obtained at right angles to each other, does not tell you everything about the trajectory / location of a structure. 

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