Nail guns are very efficient in performing construction related tasks. However, nail gun users are more prone to serious occupational risk with potentially lethal outcomes while using them. Popularly known as powered-actuated tools or cartridge compression guns, they were introduced in 1995 for both commercial and residential use in firing nails into wood, steel, and masonry.
Statistics Of Injuries Sustained
As useful as nail guns are in construction and other occupations that use these guns, they are also very dangerous. Here are the nail gun injury statistics:
- 75% of nail gun accidents affect the soft tissue whereas the remaining 25% entails structural damage- fractures, longitudinal tendon split or puncture, joint capsule penetration and neuropraxia.
- Hands take up 65% of nail gun injuries, however, the other most reported cases happen on the head, neck, chest, abdomen, and spinal cord.
- Nail gun injuries usually occur due to improper use by the operator and failure to adhere to occupational health and safety requirements while using a nail gun.
- Bump -firing happens once the operator holds down the trigger; the gun is then fired by bumping the safety bracket along the workpiece. Use of this method has led to an increase in cases of nail gun injuries.
How An Injury Takes Place
The nail gun can generate up to 1,400 feet per second velocities that can easily penetrate stressed concrete nearly 10cm deep. The energy amounts needed to result in serious injury is significantly minimal: 150 feet per second projectile velocities causes skin penetration, whereas 195 feet per second speeds may lead to bone fractures.
Nail gun injury mechanisms comprise of direct penetration, shrapnel injuries from faulty cartridges, and high-pressure injection wounds from the compressed air.
Once nail projectiles go into the tissues, the kinetic energy is transmitted from the object to adjacent tissues, leading to shock waves that develop temporary and permanent cavity spaces. While the shock waves undergo expansion, the temporary cavity earlier made results in a crush and stretch that damages your tissues. There can be increased tissue trauma if the projectile breaks bones causing the fragments to do further damage.
Assessment And Treatment Plan
A careful assessment needs to be done with a great emphasis on the nail type used; either barbed or non-barbed, injury mechanism, and the duration since the injury occurred.
Physical assessment should identify:
- Overall appearance of the hand
- Evident fractures or deformity
- Limitations on range of motion
- Proximity to vital structures
- Neurovascular status and capillary refill
Penetrating wounds cause you great pain and discomfort. Thus, you require an effective analgesia injection to enable the removal of object or nail, assessment and wound cleaning. If you happen to have finger injuries, a digital nerve block can be an efficient way of managing your finger injury, and offers better pain relief. The main benefit of a digital nerve block is that it acts away from the wound, minimizing the risk of further wound contamination.
You may also opt to use ropivacaine instead of lidocaine since it provides extended anesthetic. Your other analgesia options available include procedural sedation, Nitrous Oxide, Oral and Parenteral opioids.
Irrigation And Washout
A thorough wash out should be done to your wound. You should irrigate with normal saline first to wash away traces of debris and prevent infection.
You should use povidone-iodine solutions only in the initial stage of acute wounds management since they inhibit new tissue from granulating. Apply pressures ranging from 5 to 8 psi with the help of a 16-19 gauge needle connected to a 35-65ml syringe to adequately irrigate a wound.
You should get an ADT booster if you have suffered injuries considered to be tetanus prone and if more than 5 years have passed since your last dose.
What entails a tetanus prone wound:
- Compound fractures
- Deep penetrating wounds
- Wounds containing foreign bodies
- Wounds complicated by pyogenic infections
- Superficial wounds contaminated with soil, dust, or horse manure
The use of antibiotics in healing wounds has been termed as a contentious matter in emergency medicine, with some studies demonstrating little or no benefit in treating simple wounds, however, some reputable studies support the use of antibiotics when it comes to complex, contaminated injuries. On the other hand, if you perform proper wound cleaning and irrigation your rate of getting infections is significantly reduced.
If you are undergoing operative repair and nail removal it is highly recommended that you receive pre and post-operative antibiotics.
Referral And Follow-Up Recommendations
Most nail gun injuries to the extremities, can be treated with simple extraction and minimal debridement, and discharge with a short course of cephalosporin antibiotics. You should seek the immediate referral to a hand surgeon for an intra-operative examination if you suffer an injury to the joint space, tendons, or neurovascular bundles.
You should have proper follow up within two to three days after you are discharged from the emergency department to assess the healing of your wound.