Abstract
Cranial impalement injuries are rare. They occur from a variety of objects, and via different mechanisms. We describe the case of a 5-year old boy who suffered cranial impalement injury via a unique mechanism. He presented to our centre with an impacted 17.8cm long metallic rod (a fence spike) in the vertex of his cranium, just off the midline. The spike penetrated his head and broke off its supporting frame as the frame was falling off a collapsing brick fence. He was transported as soon as possible to the hospital by relatives, without any attempt to remove the impaled spike. An urgent cranial computerized tomogram was done, and the object was removed under general anaesthesia in the operating theatre. The patient had complete recovery and was subsequently discharged from the hospital, with no residual neurological deficit. This case demonstrates a rare mechanism of cranial impalement. It also highlights the importance of following basic principles in the management of such injuries.
Highlights
Impalement injuries describe unusual circumstances in which a foreign object penetrates and embeds in a body part
[1] Cranial penetrating injuries caused by foreign objects other than bullets or glass from traffic crashes are quite rare, and cranial impalements are even rarer. [1,2,3,4,5] This is because the head presents a much smaller target compared to the rest of the body, due to its relatively smaller surface area
The management of impaled foreign objects usually presents a challenge. This relates to removal of the object, control of haemorrhage and prevention of infection in the acute phase. [14, 15] Some of the basic principles involved include: 1. stabilization/minimal manipulation of the object before and during transportation, 2. adherence to the basic principles of airway and breathing control with control of haemorrhage + adjuncts, 3. clinical and radiological evaluation + pre-operative planning, 4. multidisciplinary approach and 5. wound care. [2, 16]
Summary
Impalement injuries describe unusual circumstances in which a foreign object penetrates and embeds in a body part. Unless an associated hematoma or infarct is present, cerebral damage caused by cranial impalement is largely restricted to the wound tract. The management of impaled foreign objects usually presents a challenge This relates to removal of the object, control of haemorrhage and prevention of infection in the acute phase. The principle of stabilization and minimal manipulation of the object during transportation, resuscitation, investigation and movement to the theatre, is one of the cornerstones of successful management as it ensures that the tamponade-like effect on damaged vascular structures is maintained, until adequate access has been achieved intra-operatively, for controlled removal of the object and prompt haemostasis. We present the case of a 5-year old boy, who suffered a cranio-cerebral impalement injury from a metallic fence spike, which penetrated his head and broke off its supporting frame He was discharged from the hospital on the 18th post-operative day, with no residual neurological deficit and no new complaints at discharge and on subsequent follow-up visits up to one year post-surgery
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