Wednesday, December 12, 2007

I promised to post pictures of this experience. But I'm so sad that the pictures don't do it justice. 2 weeks into my ER rotation I was working ER and a 43 Year old man came in with a nail in his hand. It was galvanized and 3 inches in length, he had been using a heavy duty nail gun on a deck and managed to put one (a nail) through his hand.
We did x-rays before removing it, and we were impressed that none of the bones were fractured nor did they appear to be penetrated in any way. ( Sorry I don't have anyway to scan the x-rays in). He managed to shoot the nail next to his thumb and then it exited on the back of his hand between the middle and ring fingers. Somehow the nail slipped between those bones.
Next was the problem of how to remove the nail. First we tried to use hemostats to grab the head of the nail (hemostats are like little pliers). We were unable to pull the nail out because the head of the nail was so strongly embedded in the tissue. So we sent for an orthopedic tool. ( By the way, we'd applied lidocaine to numb the area where the nail went through) The orthopedic tool was called a 'slam hammer' (I'm sure it has a more appropriate name, but that's what the ER personal called it, if anyone know the real name please email me so I can keep it strait) . I couldn't find a picture of the orthopedic device but I found something similar on a hardware site so I added that graphic to this email. unlike the one pictured ours had a set of 'vice grips' on the end which we used to grab the nail and then we used the weight to create enough force to pull the nail out in one quick stroke.
To make a long story short we were able to removed the nail with much less hassle and pain than I originally anticipated. Sorry I don't have before and after pictures.

The first picture is the entrance wound of the nail and the second picture is the exit wound from the nail.

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