What are the common causes of nail gun injuries to the hand. How should healthcare providers evaluate and treat nail gun injuries. What are the potential complications of nail gun injuries to the hand. How can nail gun injuries be prevented in both professional and non-professional settings.

Understanding Nail Gun Technology and Its Risks

Nail guns are powerful tools commonly used in construction and woodworking industries. These devices can fire nails at velocities comparable to a .22 caliber handgun, making them potentially dangerous if misused. There are two main types of nail guns:

• High-velocity devices that use explosive cartridges
• Lower-velocity pneumatic guns powered by compressed air

Both types can cause serious injuries, particularly to the hands. Why are hands so vulnerable to nail gun injuries? The radial aspect of the non-dominant hand is often used to steady materials being nailed, placing it in the line of fire.

Common Causes of Nail Gun Injuries in the Workplace

Nail gun injuries in professional settings often occur during routine use. What are the primary causes of these accidents?

• Accidental discharge of the nail gun
• Careless handling of equipment
• Overpenetration of materials by the projectile
• Ricochet or shattering of the nail
• Structural unsoundness of the receiving material

Understanding these causes is crucial for implementing effective safety measures and reducing the risk of injury in the workplace.

Types and Severity of Nail Gun Injuries to the Hand

Nail gun injuries to the hand can vary significantly in severity. What types of injuries are commonly seen?

• Soft tissue injuries with retained nails
• Direct bony injuries to digits, hand, and wrist
• Penetrating injuries to interphalangeal and radiocarpal joints
• Vascular and nerve damage
• Tendon lacerations

The severity of the injury depends on factors such as the nail’s trajectory, depth of penetration, and whether it strikes vital structures. Healthcare providers must be prepared to assess and treat a wide range of injury types.

Evaluation and Diagnosis of Nail Gun Injuries

Proper evaluation of nail gun injuries is crucial for determining the appropriate treatment. What steps should healthcare providers take when assessing these injuries?

1. Visual inspection of the wound and retained nail
2. Assessment of motor function, neurological status, and vascular integrity
3. Evaluation of range of motion to check for tendon injuries
4. X-ray imaging to identify fractures and locate nail barbs
5. Consider advanced imaging (CT or MRI) for complex injuries

A thorough evaluation helps determine the extent of structural damage and guides treatment decisions. Are there any specific challenges in diagnosing nail gun injuries? One potential pitfall is failing to identify all barbs on the nail, which can complicate removal.

Treatment Options for Nail Gun Injuries to the Hand

Treatment of nail gun injuries depends on the severity of the injury and the characteristics of the penetrating nail. What are the main treatment approaches?

Conservative Management

In some cases, minor nail gun injuries can be managed conservatively. This may include:

• Careful removal of the nail if it’s not deeply embedded
• Wound cleaning and dressing
• Tetanus prophylaxis
• Antibiotic therapy to prevent infection

Surgical Intervention

More severe injuries often require surgical management. What does surgical treatment typically involve?

• Removal of the nail under controlled conditions
• Exploration and repair of damaged structures (tendons, nerves, blood vessels)
• Debridement of devitalized tissue
• Fracture fixation if necessary
• Wound closure and appropriate postoperative care

The presence and location of barbs on the nail can significantly impact the removal process. Barbed nails may require a more extensive surgical approach to prevent further tissue damage during extraction.

Potential Complications and Long-Term Outcomes

While many nail gun injuries heal well with appropriate treatment, complications can occur. What are the potential complications of nail gun injuries to the hand?

• Infection, including tetanus and other wound infections
• Chronic pain or neuropathy
• Reduced range of motion or stiffness
• Tendon adhesions
• Complex regional pain syndrome
• Permanent loss of function or disability

Long-term outcomes depend on the severity of the initial injury, the quality of treatment, and the patient’s adherence to rehabilitation protocols. How can healthcare providers optimize outcomes for patients with nail gun injuries? Early and appropriate intervention, coupled with comprehensive rehabilitation, is key to maximizing functional recovery.

Prevention Strategies and Safety Measures

Preventing nail gun injuries is crucial in both professional and non-professional settings. What strategies can be employed to reduce the risk of these injuries?

For Professional Users

• Comprehensive training on proper nail gun use and safety procedures
• Use of sequential triggering mechanisms instead of contact trip triggers
• Regular maintenance and inspection of nail guns
• Wearing appropriate personal protective equipment, including safety glasses and work gloves
• Implementing workplace safety protocols and enforcing their use

For Non-Professional Users

• Reading and following manufacturer’s instructions carefully
• Using nail guns with sequential triggering mechanisms
• Wearing safety gear, including eye protection
• Avoiding use of nail guns when tired or under the influence of substances
• Seeking professional assistance for complex projects

How can healthcare providers contribute to prevention efforts? Educating patients about the risks associated with nail gun use and the importance of safety measures is crucial. This is particularly important for non-professional users who may be less aware of the potential dangers.

Advancements in Nail Gun Technology and Safety Features

As awareness of nail gun injuries has increased, manufacturers have developed new safety features to reduce the risk of accidents. What are some of the recent advancements in nail gun technology?

• Sequential triggering mechanisms that require the nose of the gun to be pressed against the work surface before firing
• Improved trigger lock designs to prevent accidental discharge
• Enhanced recoil reduction systems for better control
• Depth-of-drive adjustments to prevent overpenetration
• Lightweight materials for reduced user fatigue

How effective are these safety features in preventing injuries? While they have contributed to a reduction in accident rates, proper training and adherence to safety protocols remain essential. No technology can completely eliminate the risk of injury if the tool is misused.

Legal and Regulatory Considerations

Nail gun injuries can have significant legal and regulatory implications, particularly in workplace settings. What are some of the key considerations in this area?

• Occupational Safety and Health Administration (OSHA) regulations governing nail gun use in the workplace
• Employer responsibilities for providing safe equipment and adequate training
• Product liability issues related to nail gun design and manufacturing
• Workers’ compensation claims for job-related nail gun injuries
• Potential for personal injury lawsuits in cases of negligence

How can employers ensure compliance with relevant regulations? Regular safety audits, comprehensive training programs, and staying informed about the latest OSHA guidelines are essential steps. For healthcare providers, understanding these legal aspects can be important when documenting injuries and providing expert testimony if required.

Rehabilitation and Return to Work After Nail Gun Injuries

Rehabilitation plays a crucial role in the recovery process for patients with nail gun injuries to the hand. What does a typical rehabilitation program involve?

1. Early mobilization to prevent stiffness and adhesions
2. Graduated exercises to improve range of motion and strength
3. Hand therapy techniques, including massage and desensitization
4. Occupational therapy to address functional limitations
5. Pain management strategies
6. Psychological support, particularly for patients with severe injuries

How long does rehabilitation typically take? The duration varies depending on the severity of the injury, but it can range from a few weeks for minor injuries to several months for more complex cases. What factors influence the return-to-work timeline? The nature of the patient’s job, the extent of the injury, and the success of rehabilitation all play a role in determining when an individual can safely resume work duties.

Psychological Impact of Nail Gun Injuries

The psychological effects of nail gun injuries are often overlooked but can be significant. What are some of the psychological challenges patients may face?

• Anxiety about using nail guns or other power tools
• Depression related to temporary or permanent loss of function
• Post-traumatic stress disorder (PTSD) in severe cases
• Frustration with the recovery process
• Concerns about job security and financial stability

How can healthcare providers address these psychological aspects? Incorporating mental health screening into the treatment plan and providing referrals to mental health professionals when necessary can be beneficial. Support groups for individuals with hand injuries may also provide valuable emotional support during recovery.

Future Directions in Nail Gun Safety and Injury Prevention

As technology continues to advance, what are some potential future developments in nail gun safety and injury prevention?

• Integration of biometric security features to prevent unauthorized use
• Advanced sensor technologies to detect the presence of body parts in the line of fire
• Virtual reality training programs for nail gun operators
• Improved data collection and analysis of nail gun injuries to inform prevention strategies
• Development of “smart” nail guns that can adjust firing power based on material density

How might these advancements impact injury rates? While technological improvements hold promise for reducing accidents, they must be coupled with ongoing education and training efforts to maximize their effectiveness. What role can healthcare providers play in shaping future prevention strategies? By documenting and reporting nail gun injuries in detail, healthcare professionals can contribute valuable data to inform the development of safer tools and practices.

In conclusion, nail gun injuries to the hand represent a significant challenge in both occupational and non-occupational settings. Through a combination of improved technology, comprehensive training, strict adherence to safety protocols, and appropriate medical management, the incidence and severity of these injuries can be reduced. Healthcare providers play a crucial role not only in treating these injuries but also in educating patients and contributing to prevention efforts. As research continues and technology advances, it is hoped that the risk of nail gun injuries will continue to decrease, leading to safer work environments and improved outcomes for those who do sustain injuries.

Nail-Gun Injuries to the Hand

Eplasty. 2008; 8: e52.

Published online 2008 Nov 13.

, MD,^{, MD,, MD,, MD,, BA, and , MD}

Author information Copyright and License information Disclaimer

Background: The nail gun is a commonly utilized tool in carpentry and construction. When used properly with appropriate safety precautions, it can facilitate production and boost efficiency; however, this powerful tool also has the potential to cause serious injury. The most common site of nail-gun injuries in both industrial and nonoccupational settings is the hand. Materials and Methods: We report on two patients with nail-gun injuries to the hand. A review of the literature and discussion of clinical evaluation and treatment of nail-gun injuries to the hand are presented. Results: Two patients present with soft tissue injuries to the hand with the nail embedded and intact at the injury site. Operative removal of the nail and wound care resulted in successful treatment in both cases. Nail-gun injuries to the hand vary in severity on the basis of the extent of structural damage. Treatment is based on the severity of injury and the presence and location of barbs on the penetrating nail. Conclusion: Healthcare providers must understand and educate patients on the prevention mechanics of nail-gun injuries. Nail-gun injuries to the hand necessitate appropriate evaluation techniques, understanding of surgical management versus nonsurgical management, and awareness of potential pitfalls in treatment.

Pneumatic nail guns are efficient, readily available, and easy to use, making them a common tool employed in residential construction and wood-production industries.¹ In addition, nail guns are frequently utilized by the nonprofessional consumer population for general construction. The nail gun is a mechanical device used to frame wooden structures, secure wood to concrete supports, and in multiple other construction and home improvement applications. ² Powered by either an explosive charge or compressed air, this tool generates enough force to fire a projectile up to 10 cm in length, with velocities as high as 1400 feet per second, into fully stressed concrete.^3–5 This can be equated to the firing capacity of a .22 caliber handgun or rifle.^2,3,6,7 High-velocity devices eject nails by detonating explosive cartridges directly behind the gun barrel.^5,8–10 The more commonly used lower velocity nail guns, in comparison, eject nails indirectly by activating a captive piston usually by means of compressed air. In both devices energy is utilized to fire bolts, metal studs, nails, pins, and fasteners into wood, metal, concrete, and masonry by pressing a contact trip or sequential triggering mechanism on the gun.^3,7,11

Since the introduction of pneumatic-powered nail guns to the construction industry in 1959, there has been an increasing number of industrial accidents involving these devices, with the most frequent area of injury being the hand. ^5,12–14 The radial aspect of the nondominant hand, as it is typically used to grip or steady the structures being nailed, can easily cross the nail’s line of fire, and thereby is the body part most often injured.^2,12–20 Most of these workplace injuries occur during routine use and are due to accidental discharge, careless handling of equipment, overpenetration of structures by the projectile, ricochet or shattering of the projectile, and the structural unsoundness of the receiving material.^7,11 The majority of injuries involve retained nails with trauma limited to the surrounding soft tissues. Direct bony injuries to the digits, hand, and wrists as well as penetrating injuries to the interphalangeal and radiocarpal joints have been described.^5,13,14,19 Consequently, a systematic approach toward understanding the mechanisms of nail-gun injury, as well as recognizing complicating factors in the surgical management of these injuries, is essential for appropriately treating these patients. We present two cases of nail-gun injuries to the hand and outcomes of nail removal.

A 65-year-old right-handed male construction worker inadvertently fired an air-powered nail gun into his left index and middle fingers (Fig ). Visual inspection revealed that the nail was penetrating the volar soft tissue through and through the distal phalanges of the index and middle fingers. The patient complained of pain, but there were no apparent motor, neurologic, or vascular deficits. Although the range of motion was limited because of retained nail, there was no indication of tendonous injury. Two sharp barbs were protruding from the nail. The patient thought there was a third barb imbedded in his skin, but it was not observed by examination. X-ray imaging showed no evidence of associated fracture and displayed the two barbs seen on physical examination proximal to the injury site (close to the nail head) with no evidence of barbs within or distal to theinjury site (Fig ).

Open in a separate window

Nail gun framing nail injury with barbs located outside the soft tissue of the fingers.

Open in a separate window

X-ray film demonstrates no bony injury with barbs located outside the soft tissue of the fingers.

The nail was removed in the operating room. It was slowly manipulated and removed in a retrograde fashion without any obvious complications. Fluoroscopic x-ray film verified that no retained foreign bodies remained in the wound. Thorough irrigation was performed with pulse lavage. Topical antimicrobials were utilized for wound care as an outpatient. The patient’s recovery was uneventful with no residual functional deficit.

A 44-year-old right-handed male construction worker presented to the emergency department with a nail deeply embedded in his left thumb, index, and middle fingers. While house framing, he had fired an air-powered nail gun into his nondominant hand (Fig ). Pain and the retained framing nail limited the ability to assess functional status of the injured digits; however, neurologic and vascular function appeared intact. Plain film x-rays did not reveal any evidence of fracture (Figs and ).

Open in a separate window

Nail gun framing nail injury involving thumb, index, and middle fingers.

Open in a separate window

X-ray film demonstrates no bony injury to phalanges (AP [anteroposterior] view).

Open in a separate window

X-ray film demonstrates no bony injury to phalanges (oblique view).

The nail was removed in the operating room by retrograde extraction. There appeared to be no tendonous or bony injury. All puncture wounds were thoroughly irrigated and treated open with topical antimicrobial dressing. Immediate postoperative plain-film x-ray confirmed the absence of bony injury (Fig ). Daily wound care was prescribed, and the wounds healed rapidly and the patient had no functional impairment.

Open in a separate window

Postextraction x-ray film demonstrates no bony injury.

The hand is a commonly injured area of the body, with 16% to 22% of all hand injuries occurring at work.^13,21 As the average house construction requires 50,000 to 70,000 nails, nail gun use can significantly increase the speed of construction. ^10,22 Increased productivity, however, comes with an increasing number of injuries associated with the device.¹⁰ In residential carpentry, nail-gun injuries account for 14% of injuries, with more than half of these involving penetrating injuries to the hand or fingers.¹⁷ Dement et al found that nail-gun injuries were responsible for 3.9% of workers’ compensation claims in North Carolina and Ohio, with a majority comprising injuries of the hands and fingers (55%‐57%).²² Similarly, compensation claims from Washington state estimated the rate of nail-gun injuries in wood frame construction to be 2.06 per 200,000 hours worked, 66% of these injuries involving hands and fingers.^17,23,24 Not surprisingly, injuries may also be underreported because workers often seek medical attention only when the injury is deep or when the nail cannot be easily removed.¹³

Injuries associated with the use of compression guns vary widely in site and severity. ^8,18,25–28 The amount of energy required to cause serious injury is fairly low: penetration of the skin occurs with projectile velocities of 150 feet per second, whereas bony fractures may occur with projectile velocities of 195 feet per second.^7,29 In comparison, the velocity of the projectiles fired from nail guns can reach up to 1400 feet per second, leading to extensive damage when injury occurs. Although the most common site of injury in industrial and nonoccupational settings is the hand, case reports have described injuries to the thorax, abdominal wall, flank, pelvic wall, facial bones, and skull.^{2,17,26,30–32} Paralytic spinal cord transection, bowel perforation, long bone fracture, liver laceration, hemopneumothorax, blindness, cerebral damage, and even fatal injuries have been reported. ^{2–4,11,17,25,28,30–39}

When nail projectiles penetrate human tissues, the kinetic energy transfers from the object to the surrounding tissues, resulting in shock waves that form temporary and permanent cavity spaces.^7,29,39,40 As these shock waves expand, the temporary cavity created causes crush and stretch damage to tissues.^7,39,40 If the path of the projectile is influenced by yaw, tumble, or ricochet from surrounding structures, this will generally widen the extent of tissue injury. If the projectile shatters bone, these fragments act as secondary missiles, further increasing tissue trauma.^7,41

Injuries are often further complicated by contamination with skin, oil, paper, or glue. ⁴² Nails are held together with wire or paper and adhesive, which can be drawn into the wound with the nail.¹⁰ The head of the nail itself can lacerate a small portion of skin and/or clothing as it drives into the body leaving this material deep in the wound. The combination of tissue edema, devitalized tissue, and foreign matter provides an ideal environment for local infection.^2,7,43

Hand injuries can be classified as direct bony injury, injury to joint, tendon, or nerve, and isolated soft tissue injury.⁴² Despite the intricate and complex anatomy of the hand, the majority of all nail-gun injuries result in isolated soft tissue damage only. One series reported that only 25% of nail-gun injuries to the hand resulted in structural damage, including fracture, longitudinal tendon split or puncture (no division), joint capsule penetration, and bruised digital nerves or neurapraxia (without division of the nerve). Although neurovascular injury is uncommon with nail-gun injuries to the hand, the nail may be in close proximity to a neurovascular structure.^5,13 Consequently, poor understanding of the injury or failure to recognize the mechanism of injury can lead to iatrogenic injury during treatment.⁵

Of particular concern for iatrogenic injury is the presence of “barbs” on the imbedded nail.¹⁴ Copper wire fragments join nails into strips, which are preloaded into the nail gun. As the nail exits, pieces of copper wire can shear off the strip and remain attached to the nail, creating a sharp, protruding “barb,” which may be a possible source of further injury or complicate the extraction of the nail.^5,14 Open exploration and extraction of the barb under direct vision will help avoid secondary damage.

Evaluation of the patient with a retained nail in the hand begins with a careful history and physical examination. Special attention should be given to the type of nail gun used, the mechanism of injury, and the amount of time elapsed since injury onset. Status of tetanus immunization must also be determined and appropriate treatment should be given. Physical examination should note the general appearance of the hand, obvious fractures or deformity, limitations on range of motion, and proximity to important structures. Capillary refill and two-point discrimination is needed to assess neurovascular status. Absent pulses, an insensate digit, suspected joint penetration, fracture, or tendon injuries require immediate surgical consultation and operative exploration. Radiographs with a minimum of two views of the hand should always be obtained: the films must be scrutinized for associated fractures, joint penetration, and the presence of metallic barbs on the nail shaft.

Treatment of a retained nail following nail-gun injury adheres to standard principles of wound management. A single dose of intravenous or intramuscular antibiotics is often administered, usually a first-generation cephalosporin to cover skin flora contamination in uncomplicated cases. Regional blocks are usually sufficient for wound exploration and debridement. The wound and surrounding soft tissues are thoroughly irrigated with isotonic sodium chloride solution with or without the addition of antimicrobial agents. Exploration for removal of foreign material and to avoid secondary injury from nail extraction (barbs are not always visible on x-ray film) should be considered.^2,14,42

A series of 88 nail-gun injuries to the extremities noted a low frequency of infection and rapid return of function with patients who underwent nonsurgical nail removal.¹⁰ This suggests that nail-gun injuries to the extremities, when there is no articular or neurovascular involvement, can be managed with simple extraction, minimal debridement, and a short course of oral antibiotics. Specific suggestions in appropriate cases for nonoperative extraction recommend removing the head of the nail at the level of the entrance wound and withdrawing the nail slowly, in an antegrade direction, through the exit wound. ^2,15,20

In cases with suspicion of injury to the joint space, tendons, or neurovascular bundles, intraoperative exploration is indicated.⁵ Cautious nail removal with adequate wound debridement of crushed or devitalized tissue, removal of foreign material, irrigation, and open wound drainage with preoperative and postoperative antibiotic coverage is necessary.^5,19 Wounds may be left open or closed dependent upon the extent and nature of the injury and the level of contamination.⁵ Close follow-up within 48 to 72 hours postoperatively in uncomplicated cases is advised, while inpatient observation may be indicated in cases of a more significant nature.

Most accidents involving nail guns result from operator inexperience, lack of knowledge, inattention to safety precautions, or poor mechanical safety mechanisms of the nail guns.^17,22,44 Injuries occur from various circumstances, including nail ricochet, gun double firing, accidental discharges, and penetration of the receiving structure. ^{3,17,22,38,44} Nail guns should be used only by knowledgeable, educated, and experienced personnel, with proper protective clothing, and precautionary measures should be clearly displayed at all times.³⁶ Unfortunately, the incidence of industrial hand injuries remains high despite advances in health and safety awareness. Some studies have questioned the adequacy of on-the-job training and suggested more extensive operator training and improvement in protective clothing.^13,45

Revision nail-gun safety mechanisms and use of newer sequential triggers may prevent accidental misfires. The older and more commonly used contact trip trigger nail guns allow nails to discharge from the tool anytime the nose and trigger mechanism are both depressed.^13,17,22,44 Accordingly, the operator may keep the trigger depressed during rapid fire “bounce” nailing and may accidentally contact the steadying hand or other body part in lieu of the structure itself. Sequential trigger nail guns, on the other hand, require the nose of the nail gun to be depressed first—before the trigger is pressed—to fire a nail, which makes it more difficult to unintentionally discharge nails. Lipscomb et al studied 772 apprentice carpenters, carpenters with four or less years of experience, finding that approximately half of these carpenters would sustain a nail-gun injury before they completed their 4-year apprenticeship training.⁴⁴ It was also not uncommon for them to be injured more than once by a nail gun during this period. Exposure to tools with contact trip trigger mechanisms carried twice the risk of injury than did tools with sequential triggers after adjusting for training and experience.^44,45 Of the injuries noted, more than 40% of the contact trip injuries occurred when the carpenter was “bounce” or “bump” nailing. Although contact trigger use may not be the sole contributing factor, an increased likelihood of injury due to reduced control of accuracy is inevitable.

Hand injuries represent a significant cause of disability and decreased productivity in occupational and nonoccupational settings. In the case of nail guns, healthcare providers must understand and educate patients on the prevention mechanics of nail-gun injuries, be aware of the appropriate evaluation and indications for surgical management versus nonsurgical management, and recognize potential pitfalls in treatment choice.

1. Centers for Disease Control and Prevention. Nail-gun injuries treated in emergency departments—United States, 2001–2005. MMWR Morb Mortal Wkly Rep. 2007. pp. 329–32. [PubMed]

2. Braun RM. Nail-gun injury of the hand. J Bone Joint Surg Am. 1971;53:383–4. [PubMed] [Google Scholar]

3. Edlich RF, Silloway KA, Rodeheaver GT, Morgan RF, Birk K, Thacker JG. Industrial nail gun injuries. Compr Ther. 1986;12:42–6. [PubMed] [Google Scholar]

4. Lyons FR. Industrial nail gun injuries. Med J Aust. 1983;2:483–7. [PubMed] [Google Scholar]

5. Hoffman DR, Jebson PJ, Steyers CM. Nail gun injuries of the hand. Am Fam Physician. 1997;56:1643–6. [PubMed] [Google Scholar]

6. Wu WQ, Tham CF, Oon CL. Cranio-cerebral injuries from nail-gun used in the construction industry. Surg Neurol. 1975;3:837–8. [PubMed] [Google Scholar]

7. Childs SA. Nail gun injury. Orthop Nurs. 1991;10:157–8. [Google Scholar]

8. Levy AS, Lefkoe TP, Whitelaw GP, Kohler S. Management of penetrating pneumatic nailgun injuries of the knee. J Orthop Trauma. 1991;5:66–70. [PubMed] [Google Scholar]

9. Neal NC, Burke FD. High-pressure injection injuries. Injury. 1991;22:467–70. [PubMed] [Google Scholar]

10. Horne BR, Corley FG. Review of 88 nail gun injuries to the extremities. Injury. 2008;39:357–61. [PubMed] [Google Scholar]

11. Goldin M, Economu S. Stud-gun injuries. J Trauma. 1965;5:670–7. [PubMed] [Google Scholar]

12. Absoud EM, Harrop SN. Hand injuries at work. J Hand Surg [Br] 1984;9:211–5. [PubMed] [Google Scholar]

13. Kenny N, O’Donaghue D, Haines J. Nail gun injuries. J Trauma. 1993;35:9437–5. [PubMed] [Google Scholar]

14. Kenny NW, Kay PR, Haines JF. Nail gun injuries to the hand. J Hand Surg [Br] 1992;17:577–8. [PubMed] [Google Scholar]

15. Armstrong AP, Davies DM. Nail gun injury: a barbed problem. J Accid Emerg Med. 1996;13:210. [PMC free article] [PubMed] [Google Scholar]

16. Freeman BJ, Ainscow DA. Nail gun injury: an update. Injury. 1994;25:1107–1. [PubMed] [Google Scholar]

17. Lipscomb HJ, Dement JM, Nolan J, Patterson D, Li L. Nail gun injuries in residential carpentry: lessons from active injury surveillance. Inj Prev. 2003;9:20–4. [PMC free article] [PubMed] [Google Scholar]

18. Wilkes R. A social and occupational study of injured hands. Br J Ind Med. 1956;13:119–30. [PMC free article] [PubMed] [Google Scholar]

19. Van Demark RE, Jr, Van Demark RE Sr. Nailgun injuries of the hand. J Orthop Trauma. 1993;7:506–9. [PubMed] [Google Scholar]

20. al-Qattan MM, Stranc MF. Nail gun injuries of the fingers: a safer method of nail removal. J Hand Surg [Br] 1993;18:652–3. [PubMed] [Google Scholar]

21. Burke FD, Dias JJ, Heras PC, Bradley MJ, Wildin C. Providing care for hand disorders a re-appraisal of need. J Hand Surg [Br] 2004;29:575–9. [PubMed] [Google Scholar]

22. Dement JM, Lipscomb H, Li L, Epling C, Desai T. Nail gun injuries among construction workers. Appl Occup Environ Hyg. 2003;18:374–83. [PubMed] [Google Scholar]

23. Baggs J, Cohen M, Kalat J, Silverstein B. Pneumatic nailer injuries: a report on Washington State 1990–1998. Prof Safety Mag. January 2001:33–8. [Google Scholar]

24. Baggs J, Cohen M, Kalat J, Silverstein B. Pneumatic Nailer (“nail gun”) Injuries in Washington State, 1990–1998, Safety and Health Assessment and Research for Prevention (SHARP) Program. Olympia, WA: Washington State Department of Labor and Industries. Technical report No. 59-1-1999.

25. le Nobel J, Wing PC. Pneumatic nailgun injuries to the knee. Clin Orthop Relat Res. 1987;217:228–9. [PubMed] [Google Scholar]

26. Sasaoka Y, Kamada K, Matumoto M, et al. ‘Penetrating injury of the head, neck and chest by a nail-gun: a case report’ ‘Japanese’ No Shinkei Geka. 1995;23:1099–104. [PubMed] [Google Scholar]

27. Barber FA. Penetrating knee injuries: the nail gun. Arthroscopy. 1989;5:172–5. [PubMed] [Google Scholar]

28. Shibuya T, Kushi H, Miyagi A, Miyagami M, Tsubokawa T. ‘A case of penetrating head injury caused by nail-gun’ ‘Japanese’ No Shinkei Geka. 1993;21:373–7. [PubMed] [Google Scholar]

29. Ordog GJ, Wasserberger J, Balasubramaniam S. Shotgun wound ballistics. J Trauma. 1988;28:624–31. [PubMed] [Google Scholar]

30. Webb DP, Ramsey JJ, Dignan RJ, Drinkwater DC. Penetrating injury to the heart requiring cardiopulmonary bypass: a case study. J Extra Corpor Technol. 2001;33:249–51. [PubMed] [Google Scholar]

31. Jithoo R, Govender ST, Nathoo N. Penetrating nail gun injury of the head and chest with incidental pericallosal artery aneurysm. S Afr Med J. 2001;91:316–7. [PubMed] [Google Scholar]

32. Wang MJ, Chen IS, Tsai SK. Nail gun penetrating injury of the left ventricle and descending aorta. Circulation. 1999;100:e18–e9. [PubMed] [Google Scholar]

33. McCorkell SJ, Harley JD, Cummings D. Nail-gun injuries. Accident, homicide, or suicide? Am J Forensic Med Pathol. 1986;7:192–5. [PubMed] [Google Scholar]

34. Lowry JC. Industrial nail-gun injuries: a review and case report. Injury. 1973;5:59–62. [PubMed] [Google Scholar]

35. Edeland HG. Nail-bolt gun injuries. Handchirurgie. 1980;12:125. [PubMed] [Google Scholar]

36. Karlstrom G, Kjellman T. Injuries caused by nail-gun accidents. Acta Chir Scand. 1971;137:474–7. [PubMed] [Google Scholar]

37. Smoot EC, Robson MC. Acute management of foreign body injuries of the hand. Ann Emerg Med. 1983;12(7):434–7. [PubMed] [Google Scholar]

38. Beaver AC, Cheatham ML. Life-threatening nail gun injuries. Am Surg. 1999;65:1113–6. [PubMed] [Google Scholar]

39. Fackler M, Malinowski J. The wound profile: a visual method for quantifying gunshot wound components. J Trauma. 1985;25:522–9. [PubMed] [Google Scholar]

40. Berlin R. Basic ballistics. Acta Chir Scand Suppl. 1977;480:6–12. [Google Scholar]

41. Fackler M, Surinchak J, Malinowski J, Bowen R. Bullet fragmentation: a major cause of tissue disruption. J Trauma. 1984;24:35–9. [PubMed] [Google Scholar]

42. Hussey K, Knox D, Lambah A, Curnier AP, Holmes JD, Davies M. Nail gun injuries to the hand. J Trauma. 2008;64:170–3. [PubMed] [Google Scholar]

43. Tikka S. The contamination of missile wounds with special reference to early antimicrobial therapy. Acta Chir Scand. 1982;508:281–7. [PubMed] [Google Scholar]

44. Lipscomb HJ, Dement JM, Nolan J, Patterson D. Nail gun injuries in apprentice carpenters: risk factors and control measures. Am J Ind Med. 2006;49:505–13. [PubMed] [Google Scholar]

45. Tan KK, Fishwick NG, Dickson WA, Sykes PJ. Does training reduce the incidence of industrial hand injuries? J Hand Surg [Br] 1991;16:323–6. [PubMed] [Google Scholar]

Nail Gun Injuries – Special Subjects

By

Michael I. Greenberg

, MD, Drexel University College of Medicine;

David Vearrier

, MD, MPH, University of Mississippi Medical Center

Reviewed/Revised May 2022 | Modified Sep 2022

View Patient Education

Nail gun injuries, common in the construction industry, are usually puncture wounds on the hands and fingers, but sometimes they result in more serious injuries. Diagnosis is clinical; evaluation requires x-rays. Treatment is surgical.

Nail guns, which have replaced hammers in wood-frame construction, cause an estimated 37,000 emergency department visits each year; 68% of them are work-related.

Nail guns deliver nails at high velocity, which can penetrate soft tissue and bone. Most nail gun injuries involve the fingers and hand; however, injuries to the lower extremities, trunk, eyes, and head also occur. If the eyes are involved, vision may be lost. (See also National Institute for Occupational Safety and Health (NIOSH): Nail Gun Safety.)

In addition to the nail, other materials (eg, wire, fabric, paper, adhesive) can enter the wound during a nail gun injury and lead to infection.

Nail guns have been used in suicidal gestures.

Sequential steps in evaluating nail gun injuries include the following:

Patients typically present with the nail embedded in the wound. A compete evaluation of the distal neurologic, vascular, and tendinous components of the injured part is essential. In addition, plain x-rays are taken to see the general location of the nail, the type of nail, and underlying bone damage. Nails with structural barbs make removal more difficult and require exploration and removal in the operating room.

If wounds are bleeding, hemostasis must be established before evaluation. The best method is direct pressure on and, when possible, elevation of the affected part. Clamping bleeding vessels with instruments is usually avoided because adjacent nerves may be damaged. Topical anesthetics containing epinephrine may also help reduce bleeding. Careful and temporary placement of a proximal tourniquet may enhance visualization of hand and finger wounds.

Wound evaluation requires good lighting. Magnification (eg, with magnifying glasses) can help, particularly for examiners with imperfect near-vision. Full wound evaluation may require probing or manipulation and thus local anesthesia, but sensory examination should precede use of a local anesthetic.

Physicians should check for damage to underlying structures Evaluation Lacerations are tears in soft body tissue. Care of lacerations Enables prompt healing Minimizes risk of infection Optimizes cosmetic results read more , including nerves, tendons, blood vessels, joints, and bones and for the presence of foreign bodies and penetration of body cavities (eg, peritoneum, thorax). Evaluation by a specialist may be required:

• For nails embedded in bone or with neurovascular or tendinous injury: Evaluation by a hand surgeon (for hand involvement) or another relevant surgical specialist

• For nail gun injuries to the eye: Evaluation by an ophthalmologist as soon as possible

• Nail gun injuries to the head: Evaluation by a neurosurgeon as soon as possible

X-rays are taken. They help show nail location, the presence of any bone injury, and characteristics of the nail, which affect treatment; eg, nails with barbs are complicated to remove and require exploration and removal in an operating room.

Treating nail gun injuries involves

• Removal of the nail

• Wound care

Nails that are embedded in soft tissue and have no complicating injuries can be removed by firm traction (which requires local anesthesia), followed by wound cleansing, irrigation, and application of a sterile dressing (see also Lacerations Lacerations Lacerations are tears in soft body tissue. Care of lacerations Enables prompt healing Minimizes risk of infection Optimizes cosmetic results read more ). For all other nail gun injuries, the injury is explored and the nail is removed in the operating room.

Nail gun injuries are typically deep puncture injuries and should be allowed to heal by secondary intention rather than by primary intention (with immediate suturing). Tetanus prophylaxis Prevention Tetanus is acute poisoning from a neurotoxin produced by Clostridium tetani. Symptoms are intermittent tonic spasms of voluntary muscles. Spasm of the masseters accounts for the name… read more is given when indicated.

Preventive efforts involve teaching workers the correct use of nail guns and the potentially devastating effects of nail gun injuries (see NIOSH: Nail Gun Safety—A Guide for Construction Contractors and Nailing Down the Need for Nail Gun Safety).

• Nail guns commonly cause injuries, often involving nerves, tendons, blood vessels, joints, bones, or penetration of body cavities.

• Check for serious injuries with detailed examination, and take x-rays.

• Use traction to remove only nails that are embedded in soft tissue and have no complicating injuries; otherwise, remove the nail in the operating room.

• Allow most nail gun injuries to heal by secondary intention rather than trying to suture them.

NOTE:


This is the Professional Version.


CONSUMERS:



View Consumer Version

Copyright © 2023 Merck & Co. , Inc., Rahway, NJ, USA and its affiliates. All rights reserved.

Test your knowledge

Take a Quiz! 

How to treat a wound if you stepped on a rusty nail, and what to do next

• Health
• Lifestyle

On May holidays, the warm sun warms you, you want to walk on the grass, but suddenly a sharp pain in your foot pierces you! If you pierce your leg with a rusty nail, you can’t just anoint the wound with iodine. But why?

April 26, 2022

Source:

iStockphoto

It is not uncommon for the head of the family, a child, or an adult holidaymaker to step on a rusty nail. This is possible if construction is underway at the dacha, the fence is being changed or the grandmother’s plot is being dug up. It is dangerous to walk barefoot within summer cottages and buildings, especially old and dilapidated ones.

A nail can easily injure the hand or other parts of the body during repairs or other work. If the injury was caused by a rusty nail , you need to know how to treat the wound , what actions to take immediately and what to do after the bleeding stops and the pain subsides. Anvar Giniyatov, the leading traumatologist-orthopedist of the SM-Clinic in St. Petersburg, told Doctor Peter the rules for providing first aid in such a situation in a country house or nature, in the village.

What to do if you stepped on a rusty nail

First of all, you should examine the wound and try to assess its size and condition. After that, the damaged area on the leg or arm, in other parts of the body, must be treated and bandaged. And then each victim must necessarily contact a traumatologist.

Moreover, it is necessary to visit a doctor within the first hours after such a wound has been received.

The specialist will examine and check if there are any foreign bodies in the wound – pieces of metal, wood, rust.

The severity of such damage varies greatly, because nails come in different sizes, lengths and thicknesses. If the doctor during the examination suspects that the nail has pierced the bone, an x-ray will have to be taken. This is necessary in order to exclude serious, severe damage.

Read also

If a lot of time has passed

If it was not possible to go to the doctor immediately – it was not possible or due to other circumstances – and more than 12 hours have passed since the injury, then you should already contact the surgeon at the place of residence (or to the duty officer if it’s holidays). This must be done without fail, even if it seems to you that the incident was without consequences and it is not at all necessary to go to the clinic. The risk of suppuration and the development of infectious diseases with such wounds is quite high.

The wound is deep, blood is flowing

If the puncture from the nail turned out to be deep, not only the skin, but also the underlying tissues are damaged, then most likely the bleeding will be quite profuse and prolonged. Therefore, first of all, first aid will be required – you need to stop the bleeding. To do this, you will need a cotton swab, a cut of a bandage, or just a clean piece of cloth (which is at hand, since we are talking about a summer residence or nature). They should be moistened with hydrogen peroxide (should be in the car and summer first-aid kit), and then gently press this moistened swab to the wound.

When the bleeding stops, the wound should be washed immediately, twice. First with clean water and then with soap or disinfectant. You can use chlorhexidine, furatsilin or 3% hydrogen peroxide solution. It is necessary to process not only the puncture site itself, but also the skin around it.

See also

Protective wound dressing

Dressing should be applied to the washed wound. Ideally, it should be from a sterile bandage, but if one is not at hand, then a clean piece of tissue can be used. The main thing is that the bandage is clean. In the foot area, the bandage should be tighter: this will soften the load on the damaged area. After dressing, you can go to a trauma center or clinic.

Why are such wounds dangerous?

The consequences of receiving such a wound can be very serious. Especially if the nail was rusty or had lain in the ground for a long time. If I may say so, the least evil would be a severe loss of blood due to damage to the vessels or subsequent inflammation that developed. These problems can be relatively easily corrected using conservative or surgical approaches.

In the worst case scenario, a person may develop tetanus or blood poisoning – sepsis due to penetration of pathogenic bacteria deep into the tissues.

In both cases, there is a risk of death. Therefore, it is so important not to self-medicate and be sure to get vaccinated against tetanus. This is especially important for those who last had a tetanus shot while still in school or more than 5-7 years have passed since the last vaccination.

See also

Signs of complications after injury

Of course, not everyone will go to the doctor after being hurt by a rusty nail. There is always a lot to do at the dacha, there is no time to go to the doctors, because the wound seems trifling. However, after a couple of days the situation may change radically – if there is inflammation, suppuration.

Sometimes medical attention is needed immediately. For example, if the temperature rises sharply, and the wound site is very swollen, this area hurts or “burns”. In this case, it is better to immediately go to the hospital.

Author of the text: Alena Paretskaya

treatment and treatment, first aid

Wounds are:

Light

Usually they are not dangerous, but it is very important to clean them from contamination.

Serious and infected

May require first aid followed by a visit to a doctor.

Most scratches and abrasions are minor and can be treated at home.

This requires:

Stop the bleeding

Thoroughly clean the wound

Apply a plaster or bandage

Symptoms of wounds and scratches on the arm

• Violation of the integrity of the skin – the wound itself.
• Appearance of blood . It may appear in the form of drops or in the form of bleeding.
• Nerve exposure, bones after physical impact (trauma) . This fact indicates a complicated course of the wound process, so you should immediately consult a doctor.
• Occurrence of pain . The pain is usually throbbing in nature.
• Appearance of edema . May impair limb mobility.

How to treat a wound or scratch, see a short video with a surgeon Fedor Yanovich Kraskovsky

Classification of wounds and scratches according to the degree of infection (presence of pathogenic microbes)

Non-infected – only surgical wounds.

Wounds with bacterial contamination (contaminated) ^1,2,3

But without signs of inflammation (acute pain, swelling, change in skin temperature at the site of injury), resulting from injury by non-sterile objects (table knife, stick, branch, after a bite).

Purulent (infected) wounds ^1,2,3

Which are characterized by the presence of a “neglected”, complicated inflammatory process, in which the presence of harmful microorganisms is noted. Such wounds are accompanied by the development of necrosis – necrosis of the cells and tissues of the wound, the appearance of purulent discharge with a peculiar smell.

Signs of suppuration

• Edema
• Redness
• Increased skin temperature around the wound

Classification of wounds and scratches by depth

Superficial scratches and wounds 901 73

Superficial wounds or scratches usually result only in damage to the superficial layers of the skin and, if timely treatment with antiseptics, such as povidone-iodine, usually do not carry any serious danger.

Deep cuts and wounds

With deep wounds, there is a risk of damage to the vessel, nerve or ligament. If, in case of damage to the skin on the arm, in addition to painful sensations, a change in sensitivity appears, then these are signs of nerve damage.

If sensation is preserved, but movement of the finger or hand is impaired, there is a possibility of damage to the tendon.

In such cases, prompt consultation with a surgeon is necessary, who will try to restore the integrity of the damaged area.

A common wound is a finger wound

A finger wound can cause some discomfort, especially if it is in a skin fold. The wound in this place must be closely monitored, since the folds create conditions for the reproduction of bacteria

If the wound occurred on the finger, then it is necessary

• .
• Change patch frequently.

A scratch on the finger may take longer to heal due to active manual work and exposure to environmental factors. You should be patient, but it is better to briefly limit movement in order to wait for the wound to heal.

Wound of the nail plate

Another important feature of a wound or scratch on the finger is the possibility of damage to the nail plate.

The nail is an important component of the finger. It has a number of functions:

• Finger protection
• Allows precise finger movements
• Increases fingertip sensitivity

Hand Wound

The hand is the most susceptible to injury and injury as it is the most mobile part of the body.

Scratches and wounds of the hand occur during a fall, physical exertion, contact with an animal.

A feature of abrasions and scratches on the hand is that when suppurated, the inflammatory process can spread to the shoulder and forearm. In the most severe situations, this can lead to amputation of the arm. Therefore, special attention should be paid to the wounds of the hand and the damage should be treated regularly with antiseptic solutions.

Purulent wound or scratch on the arm

Suppuration of the wound is a complication. ^4.5 :

• Abscesses
• Phlegmons

Such complications arise due to the activity of harmful bacteria due to wound contamination. The condition can be worsened by the presence of foreign bodies in the wound, tissue necrosis (death of a tissue site), impaired blood supply in the area of ​​damage, improper wound treatment, and the presence of concomitant diseases, such as diabetes mellitus. The infectious process develops, as a rule, 3-5 days after the appearance of a wound or scratch.

Wound care

How to properly treat wounds to avoid complications in damaged skin areas.

More details

Treatment of a festering wound or scratch

Treatment of a festering wound should be carried out by medical professionals and usually includes the following steps: thorough treatment with antiseptics

After cleaning the wound, either secondary sutures are applied or the edges of the wound are pulled together with adhesive tape.

Treatment of wounds and scratches on the hand

First aid

Clean the wound

To do this:

• wash and dry hands thoroughly
• rinse the wound with clean water or sterile wipes
• clean the skin around the wound with antiseptic solution, avoiding getting the antiseptic into the wound itself

Stop bleeding

To do this, apply pressure to the injured area with a clean and dry absorbent material such as a bandage, towel or handkerchief.

Apply a sterile dressing or patch

The dressing must be kept clean to prevent infection. It should be changed as often as necessary. Waterproof dressings can be used to keep the wound dry while bathing and showering.

The bandage can be removed after a few days, once the wound has healed.

Take pain medication if needed

If the wound is very painful for the first few days, over-the-counter pain medication such as paracetamol or ibuprofen can be taken.

Wound care products

Various antiseptics can be used to treat wounds. They can be both in the form of solutions and in the form of ointments.

These include:

• Iodine-based solutions, including Betadine ^®
• Hydrogen peroxide – H ₂ O ₂ 9 0004
• Brilliant green
• Potassium permanganate, potassium permanganate – KMnO ₄
• Chlorhexidine bigluconate

Wound treatment with Betadine® solution

Povidone-iodine is a complex of polyvinylpyrrolidone (povidone) and iodine developed in Switzerland. Povidone promotes the gradual release of iodine. This property allows iodine to act longer at the site of application and quickly restore the affected tissue ^6,7,8 .

Povidone-iodine is the main active ingredient in the solution Betadine ^® .

The uniqueness of this remedy lies in the fact that the solution does not sting at all, and it can be used to treat the entire wound. It is important to note that Betadine ^® Solution is approved for the treatment of abrasions and abrasions even in infants from one month old. When in contact with the skin, the solution does not dry it and does not cause discomfort ⁷ .

Betadine ^® The solution is active not only against bacteria, but also promotes the death of fungi, spores, protozoa and viruses.

The iodine contained in the solution also stimulates blood flow in the area of ​​a wound ⁸ and accelerates healing ^6.8 .

Betadine ^® washes off skin and clothes easily with water.

Instruction

Where can I buy Betadine® solution?

Buy

Buy

Buy

Or

Find your nearest pharmacy

Search

Betadine® Wound and Scratch Treatment:

Can be used undiluted or diluted ⁷ . From a 10% solution, a 1% solution should be made, that is, prepared in a 1:10 dilution (for example, 1 ml of Betadine ^® and 10 ml of water or saline) ⁶ . Also, 0.9 can be used to dilute the drug.% sodium chloride solution, Ringer’s solution, or water for injection.

After dilution with blotting movements, it is necessary to treat the wound with the solution and close it with a sterile dressing.

Potassium permanganate kills bacteria, is active against fungi and has wound healing properties.

Hydrogen peroxide wound treatment

Hydrogen peroxide is suitable for treating contaminated lacerations and scratches. Peroxide is able to remove dirt and bacteria mechanically through the formation of bubbles. However, it contributes to irritation and inflammation of the edges of the wound, further disintegration of the affected cells, which makes it difficult to heal the wound ^9.10 .

Wound treatment with iodine

Iodine in the form of a 5% alcohol solution has a drying effect, but has an unpleasant burning effect.

To reduce discomfort, only the edges of the wound should be treated and the damaged area of ​​the skin should not be touched.

Frequently Asked Questions

Why doesn’t my arm wound heal?

On average, a shallow wound heals in 7-10 days. If healing does not occur during this time, an abscess remains, redness appears and the temperature rises, then you should immediately seek medical help from a specialist.

How to treat cuts on the hands?

It is enough to stop the bleeding, thoroughly clean the wound, treat it with an antiseptic and seal it with a plaster, you can apply a sterile dressing.

How to smear a wound to make it heal faster?

Iodine solutions as well as Betadine ^® have wound healing properties ¹¹ .

Betadine ^® ointment is easy to take with you to work, leisure and use at any convenient time for the treatment of wounds.

Kraskovsky Fedor Yanovich

Surgeon.

Read related

Wound care

How to properly treat wounds to avoid complications in damaged skin areas.

More

Ointment for wound healing

What are the types of healing ointments and how to choose the most effective one.

More

Infected wounds

Not all abrasions and cuts heal quickly and without complications. How to treat infected wounds?

Read more

References

1. Zavrazhanov A. A., Gvozdev M. Yu., Krutova V. A. et al. 2016.
2. Gostishchev V. et al. General surgery // GEOTAR-Media, Moscow 2015.
3. Minchenko A. Wounds. Treatment and prevention of complications // Textbook – 2014.
4. Goryunov S. V., Romashov D. V., Butivshchenko I. A. Purulent surgery: atlas // Moscow BINOM. Knowledge Laboratory, 2004.
5. Hermans MH. wounds and ulcers: back to the old nomenclature. Wounds. 2010;22(11):289-293.
6. Nosenko O. M., Moskalenko T. Ya., Rutinskaya A. V. Povidone-iodine (Betadine) in modern obstetric and gynecological practice // Reproductive Endocrinology.