Delayed femoral shaft fracture secondary to nail gun injury: a case report.

Nail gun injuries are common workplace occurrences among construction workers; however, delayed fractures of the femur after a nail gun injury are not found in the medical literature. We report the case of a patient who presented with such a fracture 3 days after accidentally firing a nail into his thigh. The patient was taken to the operating room for intramedullary nailing, irrigation and debridement, and antibiotic beads. Standard postoperative hospital care was provided, and after 2 days of intravenous antibiotics, the patient was returned to the operating room for removal of the antibiotic beads and a delayed primary closure. At the most recent follow-up, over 1 year postinjury, he had radiographic healing and was asymptomatic. Although it is difficult to predict whether the stress riser created by a nail gun injury will lead to a fracture, weight-bearing status and the aggressiveness of treatment to prevent infection are factors that need to be carefully considered in patients with this type of injury.