Penetrating head injury from nailguns: A case series from New Zealand

Winder, Mark J.; Monteith, Stephen J.; Lightfoot, Nicholas J; Mee, Edward

doi:10.1016/j.jocn.2007.06.020

Cited by 17 publications

(33 citation statements)

References 54 publications

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“…PCNIs typically present early, without significant neurological deficits [2]. This may lead to underestimation of the nature of injury, as was the case with our patient.…”

Section: Discussionmentioning

confidence: 52%

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Delayed presentation of a penetrating craniocerebral nail injury with the weapon lodged in the ventricle

Mnguni¹,

Enicker²,

Msomi³

2016

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. We report an unusual case of a 57-year-old female treated for delayed presentation of a penetrating craniocerebral nail injury following an assault. The admission Glasgow coma scale (GCS) was 14/15. The nail was lodged within the ventricle, requiring emergency removal, which was performed successfully. However, she developed ventriculitis and Escherichia coli was cultured from the cerebrospinal fluid. The GCS dropped to 8/15 necessitating an urgent CT brain scan, which showed hydrocephalus, requiring insertion of an external ventricular drain. Targeted antibiotic therapy was administered. However, she deteriorated further and demised on the fourth day of admission as a result of intracranial sepsis. Conclusion:Penetrating craniocerebral nail injury presenting with the weapon lodged in the ventricle requires urgent surgical intervention and targeted antibiotic therapy to ensure a favorable outcome.

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“…PCNIs typically present early, without significant neurological deficits [2]. This may lead to underestimation of the nature of injury, as was the case with our patient.…”

Section: Discussionmentioning

confidence: 52%

“…Nails typically cause focal tissue damage due to their small diameter [2]. They can be concealed by hair or the shaft may break off, resulting in missed injuries.…”

Section: Discussionmentioning

confidence: 99%

Delayed presentation of a penetrating craniocerebral nail injury with the weapon lodged in the ventricle

Mnguni¹,

Enicker²,

Msomi³

2016

IJCRI

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“…Compared to the large number of reports on incidents due to pneumatic, electric or gas-combustion tools, the number of reported injuries or fatalities due to powder-actuated tools (particularly direct-acting devices) today is rather small [12,17,23,24,26,38,39]. However, they do still occur, and their incidence is higher than one might expect.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to suicides committed with firearms, the main target areas for intentionally self-inflicted nail gun injuries are the head and chest [17,24,40,41]. Due to the highpenetrating power of the projectiles discharged from directacting tools, through-and-through penetrations of the victim's body are reported [5,12,42,43].…”

Section: Discussionmentioning

confidence: 99%

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Ballistic parameters and trauma potential of direct-acting, powder-actuated fastening tools (nail guns)

et al. 2011

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Since their introduction in the 1950s in the construction and building trade, powder-actuated fastening tools (nail guns) are of forensic and traumatological importance. There are countless reports on both accidental and intentional injuries and fatalities caused by these tools in medical literature. While the ballistic parameters of so-called low-velocity fastening tools, where the expanding gases act on a captive piston that drives the fastener into the material, are well known, ballistic parameters of "high-velocity" tools, which operate like a firearm and release the energy of the propellant directly on the fastener, are unknown. Therefore, it was the aim of this work to investigate external ballistic parameters of cal. 9 and 6-mm fastening bolts discharged from four different direct-acting nail guns (Type Ideal, Record Piccolo S, Rapid Hammer R300, Titan Type 1). Average muzzle velocity ranged from 400 to 580 m/s, while average kinetic energy of the projectiles ranged from 385 to 547 J. Mean energy density of the projectiles ranged from 9 to 18 J/mm(2). To conclude, this work demonstrates that the muzzle velocity of direct-acting high-velocity tools is approximately five times higher than the muzzle velocity of piston-type tools. Hence, the much-cited comparison to the ballistic parameters of a cal. 22 handgun might be understated and a comparison to the widespread and well-known cal. 9 mm Luger might be more appropriate.

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Nail projectiles propelled by a mason’s lacing cord: an experimental approach

et al. 2012

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The recent clinical observation of two unintentional penetrating ocular and cerebral injuries due to 90-mm construction nails gave occasion to an experimental study to check the alleged trauma mechanism for plausibility. Both casualties reported that they had attached a mason's lacing cord to the masonry using a nail as anchoring when suddenly the nail was yanked from its moorings and propelled like a missile by the overstretched lacing cord. As to the best of the authors' knowledge, this mechanism of injury has not yet been reported in any of the literature; it was the aim to find an experimental approach to review the plausibility of the alleged sequence of events leading to the accidents. The tensile strength at break and strain at break of different mason's lacing cords (diameter of 1 and 2 mm) were measured according to DIN EN ISO 2062 by using a tensile testing machine. Based on the maximum spring energy of the lacing cords, which was determined 174.9 J for the 1-mm cord (length 10 m) and 747.4 J for the 2-mm cord (length 10 m), the maximum possible velocity of the nails as projectiles was calculated to be 243.5 m/s for the 1-mm cord and 503.4 m/s for the 2-mm cord. The critical elongation a cord of a certain length has to be stretched to deliver enough kinetic energy to a 90-mm nail to surpass the threshold velocity for skin penetration, which was investigated by Sellier (1977) to be approximately 18 m/s, was also calculated. To conclude, the energy delivered by the cords is high enough to surpass the rather low threshold velocity of nails. The details of how these accidents occurred, which seemed questionable at first, can be reasonably explained by trauma biomechanics.

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Penetrating head injury from nailguns: A case series from New Zealand

Cited by 17 publications

References 54 publications

Delayed presentation of a penetrating craniocerebral nail injury with the weapon lodged in the ventricle

Delayed presentation of a penetrating craniocerebral nail injury with the weapon lodged in the ventricle

Ballistic parameters and trauma potential of direct-acting, powder-actuated fastening tools (nail guns)

Nail projectiles propelled by a mason’s lacing cord: an experimental approach

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