Unusual penetrating cranio-cerebral injuries in children from mains plugs

Abstract

Domestic accidents resulting in head injury are not uncommon. They mostly involve falls from high beds, tables or window seals. Rarely, children suffer penetrating skull injuries, often from unlikely objects. We present two children, 2.5- and 1.5-year-old boys, respectively, who suffered penetrating wounds and compound depressed skull fractures when they fell from moderate height and landed on nearby electric mains plugs, which were driven into their heads. None of them lost consciousness or developed epilepsy. The first patient was brought with one plug pin firmly driven into the skull in the right frontal region. Parents had disassembled and removed the rest of the plug. The second patient was brought in with the whole plug attached and one pin embedded in the left parietal region. On plain radiographs and computed tomography (CT) scan, there was complete skull perforation, a compound depressed skull fracture, and the plug pin was embedded in the brain parenchyma in both patients. In the second patient, the injury site was near the motor cortex. In both cases, the plug was surgically removed, and the skull fracture was repaired. This type of injury from the protruding ends of mains plugs is uncommon and has to be borne in mind by parents, carers and any person dealing with childhood trauma because the plug could be removed at home and the child brought to the Emergency Department with only a small wound in the scalp, hiding a potentially serious underlying brain injury.