Nail-gun injury of the cervical spine: simple technique for removal of a barbed nail

Case report

Restricted access

Although nail-gun injuries are a common form of penetrating low-velocity injury, impalement with barbed nails has been underreported to date. Barbed nails are designed to resist dislodgment once embedded, and any attempt at removal may splay open the barbs along the path of entry, with the potential for significant soft-tissue and neurovascular injury. A 25-year-old man sustained a nail impalement of the cervical spine from accidental discharge of a nail gun. The patient was noted to be fully conscious with no neurological deficits. Cervical Zone 2 impalement was noted, with only the head of the nail visible. Angiography revealed the nail lying just anterior to the right vertebral artery (VA), with compression of the vessel. Preoperatively, analysis of a similar nail revealed that orientation of the head determined position of the barbs. A deep neck dissection was then performed to the lateral aspect of the C-3 body, using the nail as a guide. Prior to removal, the nail was turned 180° to change the position of the barbs, to prevent injury to the VA. Nail removal was uneventful. The authors present a simple technique for treatment of a nail-gun injury with a barbed nail. Prior to removal, radiographic analysis of the impaled nail must be performed to determine the presence of barbs. If possible, the surgeon should request a similar nail for analysis prior to surgery. Last, the treating surgeon must have knowledge of the barbs' position at all times during nail removal, to prevent damage to critical structures.

Abbreviations used in this paper: DS = digital subtraction; VA = vertebral artery.

Article Information

Address correspondence to: Ehud Mendel, M.D., Department of Neurosurgery, N1037 Doan Hall, Ohio State University Medical Center, 410 West 10th Avenue, Columbus, Ohio 43210. email: ehud.mendel@osumc.edu.

Please include this information when citing this paper: published online April 1, 2011; DOI: 10.3171/2011.3.SPINE10718.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Plain cervical radiograph (lateral view) showing impalement by a barbed nail at the C-3 level.

  • View in gallery

    Admission CT scan demonstrating the nail traversing the right C-3 foramen transversarium only.

  • View in gallery

    A DS angiography study (lateral view) of the right VA showing the nail lying just anterior to the vessel, with mild compression. Profile and orientation of the nail head were used to determine position of the barbs.

  • View in gallery

    Photograph of a 7.5-cm-long nail from a clip, showing the eccentric position of nail head to shaft, which helps the surgeon determine the position of the barbs.

  • View in gallery

    Intraoperative photograph of deep neck dissection down to the C-3 vertebra, showing important neurovascular structures, with barbed nail in situ.

References

  • 1

    Adamo MAKenning TDrazin DDeshaies EMEmrich JF: Nail gun injury to the craniocervical junction: a case report and review of the literature. J Trauma 68:E99E1032010

    • Search Google Scholar
    • Export Citation
  • 2

    Armstrong APDavies DM: Nail gun injury: a barbed problem. J Accid Emerg Med 13:2101996

  • 3

    Buchalter GMJohnson LPReichman MVJacobs J: Penetrating trauma to the head and neck from a nail gun: a unique mechanism of injury. Ear Nose Throat J 81:7797832002

    • Search Google Scholar
    • Export Citation
  • 4

    Centers for Disease Control and Prevention: Nail-gun injuries treated in emergency departments—United States, 2001–2005. MMWR Morb Mortal Wkly Rep 56:3293322007

    • Search Google Scholar
    • Export Citation
  • 5

    Englot DJLaurans MSAbbed KBulsara KR: Removal of nail penetrating the basilar artery. Neurosurg Rev 33:5015042010

  • 6

    Hiraishi TKawaguchi TKobayashi TTomikawa MIto YFujii Y: Unstable stenosis of the internal carotid artery caused by a craniofacial nail-gun injury. Case report. Neurol Med Chir (Tokyo) 49:5905932009

    • Search Google Scholar
    • Export Citation
  • 7

    Jithoo RGovender STNathoo N: Penetrating nail gun injury of the head and chest with incidental pericallosal artery aneurysm. S Afr Med J 91:3163172001

    • Search Google Scholar
    • Export Citation
  • 8

    Kryl JStulík JVyskocil TSebesta P: [Spinal injury caused by a nail fired from a stud gun.]. Acta Chir Orthop Traumatol Cech 73:3533552006. (Czech)

    • Search Google Scholar
    • Export Citation
  • 9

    Lipscomb HJNolan JPatterson DDement JM: Prevention of traumatic nail gun injuries in apprentice carpenters: use of population-based measures to monitor intervention effectiveness. Am J Ind Med 51:7197272008

    • Search Google Scholar
    • Export Citation
  • 10

    Sasaoka YKamada KMatumoto MUeda YIwasaka THukushima T: [Penetrating injury of the head, neck and chest by a nail-gun: a case report.]. No Shinkei Geka 23:109911041995. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 11

    Selvanathan SGoldschlager TMcMillen JCampbell S: Penetrating craniocerebral injuries from nail-gun use. J Clin Neurosci 14:6786832007

    • Search Google Scholar
    • Export Citation
  • 12

    Spennato PBocchetti AMirone GSavarese LSquillante DRotondo M: Double concentric craniotomy for a craniocerebral penetrating nail. Case report and technical note. Surg Neurol 64:3683712005

    • Search Google Scholar
    • Export Citation
  • 13

    Springborg JBEskesen VOlsen NVGjerris F: Cranio-cerebral injuries caused by nail guns: report on two cases, review of the literature and treatment algorithm. J Trauma 63:E59E642007

    • Search Google Scholar
    • Export Citation

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 113 113 25
Full Text Views 45 45 0
PDF Downloads 90 90 0
EPUB Downloads 0 0 0

PubMed

Google Scholar