Steel Rod Impalement Injuries Involving the Spine: Case Reports and Literature Review

Abstract

Steel rod impalements, mostly experienced by construction workers due to falls from heights, are known entities, but only some individuals unfortunately suffer spinal cord injury. The management of the spine involved injuries is challenging due to the lack of guidelines, various clinical presentations resulting from different trajectories, and high risk of infection. We report a case of steel rod impalement involving the spinal canal and review the literature to enhance the management strategies and to identify the risk factors for possible complications, particularly infection. A 37-year-old male construction worker presented to our emergency department due to falling onto a concrete reinforcing steel rod that penetrated through his perineum to the L4 vertebra. Examination revealed paralysis and sensory loss of the left foot. The rod was removed in the operating room (closed removal) under general anesthesia, followed by laparotomy. Rectal laceration was primarily repaired, and colostomy was performed. In a separate session, laminectomy was performed. At 3 months post-discharge, the patient was ambulatory with armrest based on the same motor examination performed on presentation This case is a good example of careful preoperative planning, multidisciplinary involvement, and appropriately sequenced interventions resulting in an acceptable outcome for an injury with high morbidity and mortality and demonstrates the feasibility and potential benefits of closed removal of the rod in an operating room just before laparotomy. The presence of an intestinal perforation increases the infection risk, but infections can still be prevented in this setting. Shorter time intervals between the incidence and surgery may reduce the infection rate.

Dark-Lumen Magnetic Resonance Image Based on Artificial Intelligence Algorithm in Differential Diagnosis of Colon Cancer

“…It is a very large burden on the patient's heart and physiology [ 18 ]. Critically ill patients also need to confirm whether intestinal perforation and the cause of the disease, and the surgical conditions for colorectal endoscopy with worsening colon cancer are correspondingly complex and require specific sedatives and anesthetics when necessary [ 19 ]. Therefore, large intestine endoscopy has some limitations as a method for regular follow-up of colon cancer and long-term surveillance of colon cancer.…”

Penetrating sacral injury with a metallic pipe: a case report and literature review

“…One similar case involved a penetration injury with a steel rod [3,4]. A PubMed search returned seven cases involving penetrating injuries due to a metallic foreign body stuck in the spine without emerging from the body (Tables 1, 2) [1,[3][4][5][6][7][8][9][10]. Although rare, sacral penetrating injuries by foreign bodies, such as nails from nail guns, glass, wood, or metal, have been reported [6].…”

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Penetrating injuries such as stabbing and impalement constitute approximately 0.3% of all spinal cord injuries according to the National Spinal Cord Injury Database, and impalement with a metallic foreign body accounts for only a small proportion of such injuries [1,2]. Penetrating injuries through the torso vary widely depending on the strength of the material.

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Leg Impalement – A Rare Injury Pattern Case Report

“…However, the foreign object ends can be cut to facilitate transport, positioning, and removal [ 13 , 14 ]. Foreign body removal before surgery also has advantages: it facilitates patient correct positioning for better wound approach and prevents contact between the sterile operative field and the contaminated foreign body [ 14 , 15 ].…”

“…One of the most important therapeutic measures in these injuries is infection prevention, with wound debridement and washing with saline and prophylactic antibiotics. Anti-tetanus immunization should always be considered since most of these clinical cases occur with iron bars [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”