Citation

Stern L, Moore T. Spine 2011; 36(26): E1778-80.

Affiliation

University Hospitals - Case Medical Center, Department of Orthopaedic Surgery, Cleveland, OH; MetroHealth Medical Center, Department of Orthopaedic Surgery, Cleveland, OH.

Copyright

(Copyright © 2011, Lippincott Williams and Wilkins)

DOI

10.1097/BRS.0b013e318226771f

PMID

21673622

Abstract

Study Design: Case Report Objective: Review the literature that relates to nail gun injuries to the spine using a case report illustration.Summary of Background Data: Approximately 37,000 patients present to US emergency departments annually with injuries inflicted from nail guns, 60% of which occur in the workplace. Methods: A case report of a nail gun injury to the sacrum is presented and the pertinent literature is then reviewed. Results: A 21 yo male roofer presented to the emergency department after suffering an accidental, self-inflicted nail gun injury to the midline of his sacrum. The patient was neurologically intact and a CT of the pelvis with rectal contrast noted the nail to be located midline within the spinal canal at the level of S3 without injury to the rectum. The patient was taken to the operating room for removal of the nail under general anesthesia and exploration of the wound, specifically looking for evidence of a dural tear which was determined not to be present. The wound was closed primarily and the patient was given 24 hours of IV antibiotics followed by 2 weeks of oral antibiotics. At follow up, the patient had returned to his roofing job full time and there was no evidence of infection on exam or retained foreign bodies by x-ray. Conclusion: Based on our experience as well as a review of the literature, in terms of treating a nail gun injury to the sacrum we recommend the following: exploration in the operating room to investigate the possibility of a dural tear, thorough irrigation and debridement, especially in the case of barbed nails, and consultation with general surgery to determine if there is any injury to intra-pelvic contents prior to surgery. An infectious disease consultation post-operatively may also assist in proper selection and duration of antibiotic therapy.

Language: en