Management of Penetrating Wrist Injuries in the Emergency Department

OBJECTIVE Although several articles can be found on wrist trauma, a detailed literature search reveals limited articles that are focused specifically on penetrating puncture wounds of the wrist and the clinical approach to puncture-type penetrating wrist injuries. The number of penetrating injuries of the wrist has increased dramatically, especially since the widespread usage of the nail gun and staplegun technologies. The purpose of this article is not to analyze the approach to extensive wrist injuries and lacerations but how to evaluate and treat smaller puncture wounds that may potentially lead to significant clinical sequelae. METHODS This study describes a case of a staplegun injury to the radial artery of a 44-year-old man. The injury was treated with segmental arterial resection and anastomosis. RESULTS Postoperatively the patient had an uncomplicated course with good radial arterial flow and complete functional recovery of the hand. CONCLUSION It is crucial to be conservative and have a high index of suspicion after puncture penetrating wrist injuries. The clinical presentation varies significantly according to the anatomical structure and there may be no obvious clinical signs of injury, as in the described case. In addition, even a minor deep foreign body in the wrist should alert one for immediate operative approach, possibly with the need for microsurgical preparedness for vessel or nerve repair. Only very superficial dermal or subcutaneous puncture wounds can be safely cleaned and managed in the emergency department.