We just transported our nephew to the hospital with a nail embedded into his hand. Unfortunately, it is also attached to the piece of board he was putting the nail into. He was using a high-powered nail gun so it is well and truly connected to him now. What is the usual treatment for this? Will he have to have extensive surgery? We are beside ourselves with worry while waiting.

Once the individual has driven a nail with a nail gun into the hand, careful evaluation by the hand surgeon is required. Treatment can range from simple wound care to major microvascular surgery. The decision on how to manage the case depends on multiple factors. One important aspect of treatment is to avoid further tissue damage.

The wound must be cleaned within the zone of injury and damage repaired. Sometimes this can be done in one procedure. But when there is extensive contamination, a series of surgeries is required. In all cases, infection (and preventing infection) is a number one concern.

There are many factors to consider when determining the best treatment approach in cases like this. For example, fabric from shirt sleeves or gloves can be drawn into the wound during the
accident/incident, so the surgeon will have to look for that. X-rays are a must to look for fractures. X-rays will also help show the presence of clothing or other foreign bodies that were driven into the hand.

The surgeon will also examine your nephew for any additional injuries to the nerves, tendons, joints, and bone. This occurs in up to one-third of all cases. Some nail cartridges have “barbs” that will require extra special care when removing the nail. Sometimes the barbs are not always visible on X-rays. When barbs are present, additional soft tissue damage can be done by pulling the nail out rather than pushing it the rest of the way through. Antibiotics are standard and tetanus immunization should be updated when necessary.

With a board still attached to the hand, it’s likely that exploratory surgery to extract the nail during a surgical procedure will be necessary. However, when the surgeon finishes his or her examination, he or she will most likely let you know what treatment is advised.