Pina Gabriel, Vaz Maria Rita, Vaz Ana, Borralho Nuno
Department of Orthopaedics and Traumatology, Centro Hospitalar Tondela-Viseu, Portugal.
J Orthop Case Rep. 2021 Oct;11(10):9-12. doi: 10.13107/jocr.2021.v11.i10.2444.
Impalement injuries are defined as rare, high-energy lesions caused by foreign bodies, usually steel bars or wooden objects, which pierce body cavities or extremities and remain interposed in the perforated body region. They usually occur with road accident or civil construction falls.
A 24-year-old male patient was admitted at the emergency department after a motorcycle accident, resulting a left leg impalement with a wooden object. A partial deep peroneal nerve palsy and a proximal third fibula fracture were observed. The foreign body removal and wound debridement were performed. The patient evolved favorably without complications, with complete neurological recovery and returning to his normal life activities.
Impalement injuries represent a challenge in pre-hospital care, emergency room, and operating room hospital care, due to its rarity and specificity: Type of object, anomalous foreign body location, and trajectory. There is a consensus that whenever possible, it should be removed in the operating room, due to the foreign body may be tamponing a major arterial laceration, thus preventing massive hemorrhage.
Neurovascular injury exclusion, foreign body removal in the operating room, debridement, and antibiotic prophylaxis represent the treatment basis of these injuries.
穿刺伤被定义为由异物（通常是钢筋或木质物体）造成的罕见的高能损伤，这些异物穿透体腔或四肢并留存于穿孔的身体部位。它们通常发生于道路交通事故或建筑施工坠落事故中。
一名24岁男性患者在摩托车事故后被送往急诊科，导致左腿被一木质物体穿刺。观察到腓深神经部分麻痹和腓骨近端三分之一骨折。进行了异物取出和伤口清创术。患者恢复良好，无并发症，神经完全恢复，恢复了正常生活活动。
由于穿刺伤的罕见性和特殊性（物体类型、异物异常位置和轨迹），其在院前急救、急诊室和手术室医院护理中都是一项挑战。人们达成的共识是，只要有可能，应在手术室取出异物，因为异物可能正在压迫主要动脉撕裂处，从而防止大出血。
排除神经血管损伤、在手术室取出异物、清创和抗生素预防是这些损伤的治疗基础。
