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An image is worth a thousand words
  1. Victoria Teoh,
  2. Zakir Shariff
  1. Department of Plastic Surgery, Bradford Royal Infirmary, Bradford, UK
  1. Correspondence to Miss Victoria Teoh, Department of Plastic Surgery, Bradford Royal Infirmary, Bradford, BD9 6RJ, UK; victoriateoh{at}


Introduction This case involved a 15-year-old boy, who slipped and impaled his left hand on a wooden beam. An initial anterior–posterior radiograph was obtained prior to referral to plastic surgery for further management (figure 1).

Figure 1

Clinical photographs and initial X-ray taken of the impalement injury.

Clinical examination was restricted due to access. The patient reported general pain on limited movement of all digits but normal neurology. He received appropriate initial treatment of broad-spectrum antibiotics and tetanus care in the emergency department. His medical and social history were unremarkable.

Question What is the next most appropriate intervention?

  1. Immediate removal of the impaled structure under tourniquet control in an operating theatre.

  2. Immediate removal of the impaled structure in the emergency department under nerve block.

  3. Further imaging is needed.

  4. Urgent surgical consultation.


  • hand injury

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  • Contributors VT wrote the article and ZS supervised the report and was responsible for editing the draft write-up.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.