Important Tips for Nail Gun Removal From the Hand
There is evidence that with increased housing construction and remodeling going on after the recession during the mid-2000s, nail gun injuries to the hand have also gone up. It is estimated that half of all nail gun injuries affect the hands and fingers. Up to 14 per cent of those accidents occur during carpentry projects at home (compared with just less than four per cent among worker compensation claims). So safety at home is an important issue.

Once the individual has driven a nail with a nail gun into the hand, careful evaluation by the hand surgeon is required. Treatment can range from simple wound care to major microvascular surgery. The decision on how to manage the case depends on multiple factors. One important aspect of treatment is to avoid further tissue damage.

The following are some tips and guidelines presented by hand surgeons from the Mayo Clinic in Rochester, Minnesota when dealing with nail gun injuries to the hand:

  • Beware that fabric from shirt sleeves or gloves can be drawn into the wound during the accident/incident.
  • Watch out for additional injuries to the nerves, tendons, joints, and bone. This occurs in up to one-third of all cases.
  • X-rays are a must to look for fractures; X-rays will also help show the presence of clothing or other foreign bodies that were driven into the hand.
  • Some nail cartridges have "barbs" that will require extra special care when removing the nail. Sometimes the barbs are not always visible on X-rays. When barbs are present, additional soft tissue damage can be done by pulling the nail out rather than pushing it the rest of the way through.
  • Always conduct a thorough neurologic evaluation before numbing the area for treatment.
  • Antibiotics are standard and tetanus immunization should be updated when necessary.

    The wound must be cleaned within the zone of injury and damage repaired. Sometimes this can be done in one procedure. But when there is extensive contamination, a series of surgeries is required. In all cases, infection (and preventing infection) is a number one concern.

    The authors provide surgeons with specific information on techniques for nail extraction. Patient photos at the time of admission and interoperative photos are provided with a description of how-to remove the nail and any item it may still be attached to (often a piece of board). When to perform exploratory surgery and when to extract the nail during a surgical procedure are discussed in detail. How to handle contaminated nails that have entered the bone is an additional feature of this article.

    The authors end by reminding surgeons of the need for patient safety education. It may seem like common sense that a first injury would be a wake-up call to use protective gear but many patients have more than one episode of nail gun injuries to the hand. Gloves, goggles, and helmets are advised. The National Institute for Occupational Safety and Health (NIOSH) has a nail gun safety guide for construction contractors that can be just as informative for the do-it-yourself home owner.
    References
    Peter C. Rhee, DO, MS, et al. Nail Gun Injuries to the Hand. In The Journal of Hand Surgery. June 2013. Vol. 38A. No. 6. Pp. 1242-1246.