Nail Puncture Research Articles

Urgent Management of Penetrating Ocular Injury: A Case Report and Review of the Literature.

Ocular globe injury is a severe ophthalmic emergency that requires immediate attention in the emergency department. In this case report, we present a 35-year-old male who suffered a penetrating ocular injury and globe rupture caused by a nail puncture. The patient presented with severe pain and visual loss and was treated with tetanus vaccination, empirical antibiotics, and pain control, followed by an urgent orbital computed tomography (CT) scan and consultation with an ophthalmologist. The CT scan revealed a retained nail in the ocular space, and an urgent operation was performed to repair the eyeball rupture, remove the intraocular foreign body, and perform an anterior vitrectomy. The patient was discharged 6 days after the operation with a visual acuity of 20/400 and an ocular trauma score of 34. This case highlights the importance of initial emergency physician decision-making and the need for a thorough history-taking and examination when encountering penetrating ocular injuries.

Trend and Epidemiology of Tetanus in Nasarawa State, Nigeria: A Five Years Review

Background: Tetanus is a vaccine preventable, non-communicable disease known as lockjaw and characterized by muscle spasm. It is a forgotten disease in the developed world but remained an infection of public health importance in the developing countries. This study aimed to determine the trend in its epidemiology and outcome in Nasarawa state. Subjects and Method: A retrospective study using secondary data from the medical records of three selected health facilities, one each across the three senatorial zones of the state. All those who had tetanus were included while those with incomplete records, 5 were excluded. Data analysis was done using a statistical package for social sciences version 23. The dependent variable was the outcome of tetanus while the independent variables were incubation period, onset period, type of tetanus, risk factors, vaccination history, and manifestations of tetanus. Results: The subject consists of 53.8% males and single with age (Mean=15; SD=6.90). Four and 17 days were the shortest and longest incubation periods while one and six days were the shortest and longest onset periods respectively. A total of 24 (93.3%) patients had generalized tetanus. Nail puncture, road traffic accidents, and umbilical infection were the commonest sources of post-neonatal and neonatal tetanus in this study. Spasm is the commonest manifestation, present in 19 (73.1%) of the study population. This is closely followed by trismus in 57.7% of the cases. About half have a positive vaccination history. This study found case fatality of 7.7%. Conclusion: Generalized tetanus was the commonest type seen in this study, while nail puncture, road traffic accident and umbilical infection were the most common sources of infection. Although, more than half of the study subjects received immunization to prevent tetanus, the case fatality in this study was in one in twelve sufferers. Keywords: Epidemiology, review, tetanus, trend. Correspondence:Bello Surajudeen Oyeleke. Department of Paediatrics Dalhatu Araf Specialist Hospital. Shendam Road, PMB 07, Lafia, Nasarawa State. Email: surajudeenbello4@gmail.com. Mobile: +2347064641540.

Predicting the discharge capacity of a lithium-ion battery after nail puncture using a Gaussian process regression with incremental capacity analysis

This work uses a Gaussian process regression to predict the discharge capacity of small Lithium-ion pouch cells after a nail puncture. Previous studies have shown that cells can operate at a reduced capacity after experiencing abuse similar to what can be seen during extreme field operation, where the ability to predict cell functionality can be critical to safety. Other studies have shown that different features of cell incremental capacity curves can be used to determine the extent of cell degradation during normal operation, which can be used to predict future operation. For this work, 15 cells are punctured with a nail and allowed to continue operating for 100 total cycles to collect data. The incremental capacity curves are calculated, then the magnitude and corresponding voltage of the highest peak are determined. A Gaussian process regression is used to predict the discharge capacity during operation after the nail punctures. The results show a mean coefficient of determination of 0.923 with a median value of 0.95, a mean root mean square error of 0.013 and median value of 0.09, and a mean absolute error of 0.011 with a median value of 0.08, indicating the regression can be useful in predicting discharge capacity.

Investigation of physical effects on prismatic lithium-ion cell electrodes after partial nail puncture using Raman spectroscopy and incremental capacity analysis

Continued cycling of Li-ion batteries after physical damage can pose operational and safety concerns. Whether batteries can continue providing the energy required for their intended application, as well as the possibility of increased risk of catastrophic damage, are of great interest. The focus of this work is to determine the physical effects on a prismatic Li-ion cell that experiences a partial nail puncture and continues operating afterward. The cells under test experience a nail puncture early in their life, then are allowed to continue cycling for different lengths of time to investigate the effects of the damage at different points in their lifetime. The results show that nail punctures cause an uneven distribution of current beyond what is normally expected in an undamaged cell, as well as accelerated degradation due to the exposure to atmosphere. Raman spectroscopy analysis is used to determine the physical change in anode and cathode materials in relation to the proximity to the nail puncture. Incremental capacity analysis is also used to investigate the effect on the operation of the cells and determine how the change in material and current distribution influenced the accelerated rate of degradation in the cells. The results show that while cells are capable of continuing operation after being damaged, their output and lifetime are severely reduced.

Nail Puncture Wound Through a Rubber-Soled Shoe: Should We Take Every Patient to the Operating Room?

Nail puncture wounds through rubber-soled shoes, when presenting acutely, have a deceivingly benign appearance. High index of suspicion for a retained rubber piece should be maintained by the physician. This study investigates whether preoperative ultrasound examination can rule out a foreign body and reduce the need for surgery. It is a retrospective cohort of 125 patients with deep nail puncture wounds through a rubber-soled shoe, who underwent surgical exploration between 2008 and 2018. All patients had a preoperative ultrasound examination for detection of a rubber foreign body. The patients’ median age was 29, and 112 (89.6%) were males. Median time of presentation was 1 day, but there were patients who presented up to 90 days after injury (mean 5.1 ± 15.6 days). Foreign bodies, ranging 1 to 4 mm in diameter, were surgically removed in 37 (29.6%) patients. Only 16 of these patients had a positive preoperative ultrasound examination, corresponding to sensitivity of 43.2%. Specificity of the ultrasound examination was 95%. Ultrasound examination has low sensitivity for detection of foreign bodies following a puncture wound of the foot. This is attributable to the small size of the foreign bodies in this scenario and to the complexity of sonography in this location. We conclude that ultrasound cannot be used to rule out foreign body in the foot, and should not be relied on when deciding to avoid surgery. Nevertheless, it can be a helpful adjunct preoperatively, as an assessment of the foreign body size and location.

Determining the effects of non-catastrophic nail puncture on the operational performance and service life of small soft case commercial Li-ion prismatic cells

This work focused on the operational effects of Li-ion batteries (LIBs) that had been partially damaged and were allowed to continue operating afterwards. The intent was to simulate the operation of a damaged cell in an abusive environment, such as that found in electric vehicles and hybrid-electric vehicles. A test rig implementing a drop hammer with a nail attached was used to puncture approximately halfway through cycling LIBs to determine how their operation was affected. For all LIBs tested, the puncture caused a rapid spike in temperature. The dynamic impact immediately caused an initial drop in capacity of approximately 11%, and capacity continued to decrease throughout the remainder of the cycles. The cells also reached their end of life within an average of 43 cycles after the puncture, much sooner than the rated lifetime. Postmortem analysis of the punctured LIBs presented impact induced physical damage to the electrodes, oxidation of the electrolyte, and degradation of the interior components of the cells. This caused a decrease in discharge capacity and shortened useful lifetime due to hindering the charge capability of the cells. The degradation mechanism of the cells was further determined using peak tracking of the incremental capacity curves throughout their lifetimes.

PEMANFAATAN GEOFENCE UNTUK MENCARI LOKASI BENGKEL TAMBAL BAN TERDEKAT BERBASIS ANDROID

The number of vehicles in Indonesia continues to increase every year. It will also be directly proportional to many people who have problems with their vehicles, such as finding a tire leaking from a nail puncture or other causes. And will also increase the need for tire services. For vehicle users who do not know the area around when experiencing leak tire disaster, then directly proportional to search for the nearest tire repair shop will be difficult. Therefore, in this study developed information media in the form of Android-based applications to map the locations - workshop tire repair shop, as well as search for the nearest tire patch based on the location of the rider by using geofence system, where in this application the user will be notified the nearest workshop with a blink on the animated image tire repairs. From the test results, this application is able to help users search for the nearest tire repair shop along with the distance from the user location. This application is also able to show related information as well as showing the distance and route of the road that will be taken from the location of the user with the location of the intended tire patch by utilizing google maps applications. Applications have been tested by questionnaire method distributed to 30 respondents with 10 questions and the results of the questionnaire calculated using the likert scale get 76,2% results and included in either category

Endogenous presumed bacterial endophthalmitis of the right eye following cellulitis of the right leg

Endogenous endophthalmitis is a very rare but potentially devastating intraocular inflammation resulting from haematogenous spread of pathogens to the eye. We present a case of a 26-year-old male adult who had a nail puncture injury to the sole of his right foot and developed swelling of the that foot and leg associated with severe pain and fever five days later. While being managed in a private clinic as a case of cellulitis of the right leg, he developed ocular pain, redness and diminution of vision in the right eye but was attended to five days later by the ophthalmologist who made a diagnosis of endogenous presumed bacterial endophthalmitis in an already blind right eye secondary to septicaemia. With 15 days of systemic antibiotics, the ocular and systemic findings resolved. The eye became pthisical on follow-up. Endogenous endophthalmitis is associated with poor visual prognosis and early intervention is the only sure way to improve visual outcome.

A flexible lithium-ion battery with quasi-solid gel electrolyte for storing pulsed energy generated by triboelectric nanogenerator

Sustainable operation of flexible and wearable electronic devices is possible with energy harvested from environment, but such power could be in the form of pulses with varying amplitude and frequency. In this work, we prepared quasi-solid lithium-ion batteries (LIBs) for storing the energy generated by a triboelectric nanogenerator (TENG). The lithium-ion batteries composed of a gel electrolyte, LiFePO4 cathode and metallic lithium anode can deliver a capacity of ~ 140mAhg−1 at 0.2 C rate and ~ 120mAhg−1 at 1 C rate. A flexible pouch cell was further fabricated with this quasi-solid electrolyte, which shows good flexibility, high mechanical strength and excellent safety against the nail puncture. The flexible LIB was used to store the pulse form energy harvested by a TENG to provide more stable power output sustainably. The quasi-solid LIB can be charged by TENG directly for three times with a capacity loss of 17%. Importantly, a power management unit (PMU) was designed to make the output of TENG to be more suitable for charging the flexible LIBs. Our results show that this PMU is beneficial for decreasing the output voltage of TENGs, thus improving the cyclability of the cell, which may be utilized in various systems consisting of different batteries and TENGs.

Chronic Expanding Hematoma in the Popliteal Fossa after Pseudoaneurysm Surgery because of Nail Puncture.

Hematomas caused by surgery or trauma that persist and expand slowly for more than a month are defined as chronic expanding hematomas (CEH). Magnetic resonance imaging (MRI) is useful for the diagnosis. Total excision with the pseudocapsule is the treatment method. Pseudoaneurysms result from arterial wall disruptions and can be mistaken for CEH. We present a rare case report of a 45-year-old man with a large, painful swelling in his left popliteal fossa. He had a puncture wound by a nail 11 years ago and a gradually expanding mass occurred in his popliteal fossa. A pseudoaneurysm was detected and operated a year later. After surgery, a gradually expanding mass recurred in his popliteal fossa. On the arteriography, the popliteal artery was occluded and the blood flow was maintained with collateral vessels. On MRI, an enormous swelling of 115 × 107 × 196 cm in diameter was seen. It was diagnosed as CEH and was excised completely protecting the collateral vessels and there was no recurrence after a year from the surgery.

Finger Tendon Travel Associated with Sequential Trigger Nail Gun Use

OCCUPATIONAL APPLICATIONS This article reports a method for assessing finger tendon motion associated with the use of a sequential actuation trigger pneumatic nail gun. The two-stage actuation process of the sequential actuation trigger reduces risk of nail puncture injury from unintended nail discharge (relative to the higher risk of the contact actuation trigger). However, widespread adoption of the sequential actuation trigger nail gun throughout the construction industry has been hindered by beliefs about productivity and musculoskeletal concerns about the repetitive trigger actuation and finger motion for each nail fired. Though existing guidelines for finger tendon travel exposure are not well established, predictions derived with the present method combined with productivity standards suggest insufficient evidence to contradict the safety-based recommendation to adopt the sequential actuation trigger trigger. TECHNICAL ABSTRACT Background: Pneumatic nail guns used in wood framing are equipped with one of two triggering mechanisms. Sequential actuation triggers have been shown to be a safer alternative to contact actuation triggers because they reduce traumatic injury risk. However, the sequential actuation trigger must be depressed for each individual nail fired as opposed to the contact actuation trigger, which allows the trigger to be held depressed as nails are fired repeatedly by bumping the safety tip against the workpiece. As such, concerns have been raised about risks for cumulative trauma injury, and reduced productivity, due to repetitive finger motion with the sequential actuation trigger. Purpose: This study developed a method to predict cumulative finger flexor tendon travel associated with the sequential actuation trigger nail gun from finger joint kinematics measured in the trigger actuation and productivity standards for wood-frame construction tasks. Methods: Finger motions were measured from six users wearing an instrumented electrogoniometer glove in a simulation of two common framing tasks—wall building and flat nailing of material. Flexor tendon travel was calculated from the ensemble average kinematics for an individual nail fired. Results: Finger flexor tendon travel was attributable mostly to proximal interphalangeal and distal interphalangeal joint motion. Tendon travel per nail fired appeared to be slightly greater for a wall-building task than a flat nailing task. The present study data, in combination with construction industry productivity standards, suggest that a high-production workday would be associated with less than 60 m/day cumulative tendon travel per worker (based on 1700 trigger presses/day). Conclusion and Applications: These results suggest that exposure to finger tendon travel from sequential actuation trigger nail gun use may be below levels that have been previously associated with high musculoskeletal disorder risk.

T8 spinal cord transection in a 6-year-old child

Study design: Case report.Objective: To describe a case of spinal cord transection in a 6-year-old child.Background information: Non-missile injury of the spinal cord is not common and its incidence varies according to the country. In addition, to our knowledge, there are no published reports of spinal cord injury (SCI) from a penetrating nail. Here, we report the case of a child who developed complete SCI because of cord transection by a nail.Methods: A detailed history and physical examination were performed along with careful review of the patient's medical records. In addition, a review of the literature was conducted to assess the incidence and treatment of similar injuries.Case description: A 6-year-old boy was admitted to the hospital after falling from a tree and landing on a nail. His physical examination revealed an emaciated child with multiple decubitus ulcers, lying on his side in bed. Visible was a well-healed posterior puncture wound at the T8 vertebral level. On neurological examination, the patient had 0/5 muscle strength in his lower extremities, symmetrical areflexia, and hypoesthesia below the T8 level. Plain x-ray of the thoracolumbar spine was normal. Magnetic resonance imaging revealed a transected spinal cord at the T8 vertebra, consistent with his nail puncture wound.Discussion: This report describes an unusual case of a complete SCI in a pediatric patient caused by penetrating trauma from a nail. To our knowledge, this is the first case to report on complete SCI due to trauma from a nail.

Nail Puncture Wound Through a Rubber-Soled Shoe: A Retrospective Study of 96 Adult Patients

Nail punctures through rubber-soled shoes expose the foot to the possibility of deep infection and foreign body retention. In this article, we describe characteristics of adult patients who sustained nail puncture wounds through a rubber-soled shoe and were treated at our institution from January 1, 2000, to January 8, 2008. Of the 96 patients, 36 (37.5%) were treated conservatively and 60 (62.5%) were treated surgically in the operating room. Of those treated surgically, 15 (25%) had a foreign body extracted during the operation. The operated group had a longer duration of time from injury to hospital admission than did the nonoperated group (5.0 ± 6.8 days versus 2.7 ± 3.8 days, P < .05). Treatment success was observed in 91 (94.8%) of the patients, and the median lag time before admission for the less successfully treated group was longer than that for the successfully treated group (10 days versus 2 days, P < .002); and, the less successfully treated group was more likely to receive antibiotics in the community before hospitalization (100.0% versus 47.2%, P < .06), and was more likely to be diabetic (40.0% versus 9.9%, P < .10). Fever, white blood cell count, and erythrocyte sedimentation rate were not significantly associated with treatment outcome. Success of the treatment did not depend on white blood cell count, erythrocyte sedimentation rate, or fever. Ultrasonography was useful in detecting the presence of a foreign body.

Rapidly Developing Gas Gangrene Due to a Simple Puncture Wound

Gas gangrene, an infection caused by Clostridium perfringens, is a potentially fatal and physically disabling disease due to its sometimes incredibly rapid progression. An adolescent boy was referred to our university hospital with a history of nail puncture in the hand that occurred a few hours previously. The physical examination revealed a swollen and tender arm with crepitations up to the shoulder. Gas was coming out from the puncture wound with digital pressure on the forearm. The plain radiograph of the arm was typical of gas gangrene with the presence of gas under the skin and between muscular fibrils.Having received 1 dose of meropenem, the boy had surgery, in which his entire upper extremity had to be disarticulated from the shoulder. The maintenance antimicrobial therapy with intravenously administered penicillin G and clindamycin was continued for a duration of 10 days, at the end of which, the patient was discharged.The rapidly progressive character and the dramatic ending of this case made us wonder whether antimicrobial prophylaxis would play any role in the preventive management of puncture wounds.

Calcaneal osteomyelitis: an analysis of aetiology and pathogenic organisms

Forty-nine cases of calcaneal osteomyelitis in 47 patients were evaluated between 1984 and 1993. Data on all osteomyelitis patients was collected prospectively in a computer data base. This data was reviewed to determine aetiology, pathogenic organisms and host characteristics of the patients. Aetiology was divided into five groups: diabetes mellitus (n = 21); central nervous system lesion (n = 10); post-traumatic (n = 9); nail puncture wounds (n = 5); and other (n = 2). Each case was staged using the Cierny-Mader classification for osteomyelitis: IIA (n = 3); IIB (n = 16); IIIA (n = 10); IIIB (n = 18); IVB (n = 2). Pathogenic organisms were categorized by each type of aetiology and host (A = uncompromised, B = compromised). Compromised hosts and patients with impaired sensation had more organisms cultured than uncompromised hosts. Treatment consisted of culture specific antibiotics (all); irrigation and debridement/partial calcanectomy (29); debridement with free flap (three); below knee amputation (10) and above knee amputation (one). All amputations were done in B hosts with impaired sensation. Eight of the 11 amputations were in diabetic patients. Patients with impaired sensation more commonly had multiple organisms cultured from their wounds and had a higher rate of amputation.

Pseudomonas osteochondritis complicating puncture wounds of the foot in children

Puncture wounds of the foot in children become infected in only 3% to 15% of initial injuries. Typically, the earliest infections seen complicating nail puncture wounds are caused by Staphylococcus aureus and various species of Streptococcus. Osteochondritis caused by Pseudomonas aeruginosa and other gram-negative enteric organisms is the second most common infection. A well-established correlation exists between puncture wounds to the foot through a tennis shoe and osteochondritis approximately 7 to 14 days from the time of the injury. However, puncture wounds to the foot associated with other types of shoes, and even with bare feet, have been described. The appropriate management for Pseudomonas osteochondritis complicating foot wounds in children is effective surgical debridement of all infected and necrotic tissue, removal of any foreign body, and appropriate antibiotic therapy. The overall complications from nail puncture wounds to the foot are related more to the initial injury than to infection when effective surgical/medical management is instituted.

Oral ciprofloxacin for treatment of infection following nail puncture wounds of the foot.

From January 1990 to December 1993, 23 adults were hospitalized at our institution for treatment of foot infections that occurred following nail puncture wounds. All 23 patients had cellulitis, and 14 had signs of osteochondritis on a roentgenogram or a 99mTc bone scan. After undergoing surgical intervention that consisted of debridement, drainage of the pus, and exploration of the bones, patients received intravenous ciprofloxacin (400 mg b.i.d.) for 24 hours, followed by an oral regimen (750 mg b.i.d.). Nine patients with cellulitis received oral therapy for 7 days, and the 14 patients with osteochondritis received oral therapy for 14 days. Isolates that were recovered included Pseudomonas aeruginosa (18 patients) and Staphylococcus aureus (2 patients); one patient had a mixed infection, and in two cases no pathogens were recovered. All of the isolates were susceptible to ciprofloxacin. All patients were cured, and none had reinfection. Our results show that foot infection following a nail puncture wound may be treated with oral ciprofloxacin (750 mg b.i.d.) for 7-14 days, provided that surgery is performed first.

Osteomyelitis

Infections involving bone continue to be a common problem. In children this is usually an acute haematogenous osteomyelitis. Early diagnosis with culture of an aspiration specimen is of paramount importance. Treatment with antibacterial agents is often successful unless pus is obtained in aspiration. In cases with an established abscess, surgical drainage is often needed in addition to antibiotic treatment. Staphylococcus aureus is the most common causative organism, although other microbes are often found in special circumstances such as in neonates, patients with sickle cell disease and those with nail puncture wounds. In adults, a pyogenic osteomyelitis is often due to direct trauma and generally is chronic in nature. Surgical debridement is the mainstay of treatment in these cases. Antibiotic treatment is often helpful but not curative by itself. Fungal and mycobacterial osteomyelitis is especially common in immunocompromised hosts. Amphotericin B remains the preferred treatment for fungal infections. Long term antituberculous multiple drug therapy is often sufficient to treat mycobacterial osteomyelitis.

An update on the evaluation and management of plantar puncture wounds and Pseudomonas osteomyelitis

The management of children who present to the ED with plantar puncture wounds is dependent upon the nature of the injury, the examination of the puncture site, and the potential risk of a retained foreign body. Not all patients will require wound enlargement and a search for a retained foreign body. Close follow-up of all children who are being treated as outpatients is of vital importance in detecting an early development of an infectious complication. Pseudomonas osteomyelitis should be suspected in all patients who present with foot pain, swelling, and a decreased ability to bear weight after sustaining a nail puncture through a sneaker. The current consensus favors open surgical débridement followed by a course of intravenous antibiotics. The exact duration of the postoperative antibiotic course is still being debated.

Pseudomonas Osteochondritis Complicating Puncture Wounds of the Foot in Children: A 10-Year Evaluation

From 1978 to 1988, microbiologically proven Pseudomonas osteochondritis and septic arthritis following nail puncture wound to the foot was diagnosed in 77 children aged 18 mo-19 y (77 and 17 cases, respectively). The syndromes were found in children with a history of wearing tennis shoes (70 cases), other shoes (5), and no shoes (2). All cases had surgical debridement of the infected cartilage or bone and drainage of infected joints. Pseudomonas aeruginosa was isolated in 38 cases and in conjunction with Staphylococcus aureus in 18. Anti-Pseudomonas antibiotics were initiated in all cases before surgical exploration; the average duration of treatment was 7.5 +/- 1.2 d postoperatively. Patient follow-up was 5.2 +/- 3.4 y (median, 4.8 y; range, 3 mo-10 y). Two relapses occurred; both patients had a previously undetected septic arthritis. These data suggest that with aggressive surgical management, Pseudomonas osteochondritis and septic arthritis can be treated effectively with postoperative antibiotics for 7 d.