Background
In 2018, trade workers had the highest number of ACC claims by occupation (18% of all work related claims)1. Nail guns are common tools used in construction and are usually powered by compressed air, fired as fast as 1400 feet per second2. An average house requires 60,000 nails in construction and unsurprisingly the most frequent area of injury is the radial aspect of the non-dominant hand as this is typically used to stabilised the structure being nailed2. Studies show hands and fingers bear the brunt of injuries from nail guns (50-66%)3,4.
This fascinating case report illustrates a handy way of removing a nail embedded in a patient’s finger.
Methods
Mr A, a fit and well 23 year old right hand dominant building apprentice was admitted to the Emergency Department (ED) after sustaining a nail gun injury at work.
On examination, the nail (approximately 7cm) was embedded through the radial aspect of the left index finger proximal to the distal interphalangeal joint (DIPJ) and into a 4x2 wooded plank. Sensation was clinically intact so a ring block was administered prior to X-ray.
The patient’s glove was cut away and a plastic skin graft board was used to protect the skin of the volar finger while a thin saw was used to carefully cut the nail with the adjunct of medical lubricant. Once the wood was detached from Mr A’s hand the nail was gently removed retrograde and the tract washed out.
Results
The nail was removed without complication. A repeat X-ray showed a residual barb remaining within the finger therefore the patient was booked for an operation for removal later that day. He had an unremarkable recovery.
Conclusion
This case report describes an innovative and effective way of removing a nail and may prove useful with this common ED presentation.