Impalement Injury to Thigh: A Case Report with Review of Literature

Abstract

Introduction: Impalement injuries are one of the rare presentations in the emergency department and present complex surgical challenges in management. Prompt transfer to tertiary centre, pre-operative planning, and multi specialty involvement is crucial in the management of such cases.

Case report: We report a case of 18-year-old male who sustained impalement injury to thigh with an iron rod after falling from height. After quick assessment ofv ital parameters and ruling out major organ injury, wound extent was examined. In collaboration with vascular and plastic surgeons, the rod was successfully removed under direct vision. The patient recuperated without sequelae.

Conclusion: One should not get distracted by the appearance of the impalement injuries. After initial resuscitation, full trauma evaluation should be carried out before attending to local injury. Minimal manipulation, extraction of impaled object in operation theater under direct vision, wound debridement, and administration of antibiotics to prevent wound infection are pearls of the management of impalement injury.

Keywords: Penetrating injuries; extremity involvement; metal rod.

Figure 1

Photograph showing impalement of rod in left thigh.

Figure 2

Photograph showing exit wound of rod in left thigh.

Figure 3

Roentgenogram showing anteroposterior view of proximal femur.

Figure 4

Roentgenogram showing lateral view of proximal femur.

Figure 5

Photograph showing position ofpatient on operating table.

Figure 6

Photograph showing exploration of exit wound and retraction of neurovascular structures.

Figure 7

Photograph showing insertion of wide bore tube to irrigate wound track.

Figure 8

Photograph showing dimensions of iron rod.

Figure 9

Diagrammatic representation showing trajectory of iron rod.