Nail Gun Injury to the Sacrum

Study Design. Case report. Objective. Review the literature that relates to nail gun injuries to the spine using a case report illustration. Summary of Background Data. Approximately 37,000 patients present to the US emergency departments annually with injuries inflicted from nail guns, 60% of which occur in the workplace. Methods. A case report of a nail gun injury to the sacrum is presented and the pertinent literature is then reviewed. Results. A 21-year-old male roofer presented to the emergency department after suffering an accidental, self-inflicted nail gun injury to the midline of his sacrum. The patient was neurologically intact and a computed tomography (CT) of the pelvis with rectal contrast noted the nail to be located midline within the spinal canal at the level of S3 without injury to the rectum. The patient was taken to the operating room for removal of the nail under general anesthesia and exploration of the wound, specifically looking for evidence of a dural tear, which was determined not to be present. The wound was closed primarily and the patient was given 24 hours of intravenous antibiotics followed by 2 weeks of oral antibiotics. At follow-up, the patient had returned to his roofing job full-time and there was no evidence of infection on examination or retained foreign bodies by radiograph. Conclusion. On the basis of our experience and a review of the literature, in terms of treating a nail gun injury to the sacrum we recommend the following: exploration in the operating room to investigate the possibility of a dural tear, thorough irrigation, and debridement, especially in the case of barbed nails, and consultation with general surgery to determine if there is any injury to intrapelvic contents before surgery. An infectious disease consultation postoperatively may also assist in proper selection and duration of antibiotic therapy.