Cranial Impalement of a Falling Fence Spike in a Child: A Case Report

Abstract

Abstract:Cranial impalement injuries are rare. They occur from a variety of objects, and via different mechanisms. We describe the case of a 5-year old boy who suffered cranial impalement injury via a unique mechanism. He presented to our centre with an impacted 17.8cm long metallic rod (a fence spike) in the vertex of his cranium, just off the midline. The spike penetrated his head and broke off its supporting frame as the frame was falling off a collapsing brick fence. He was transported as soon as possible to the hospital by relatives, without any attempt to remove the impaled spike. An urgent cranial computerized tomogram was done, and the object was removed under general anaesthesia in the operating theatre. The patient had complete recovery and was subsequently discharged from the hospital, with no residual neurological deficit. This case demonstrates a rare mechanism of cranial impalement. It also highlights the importance of following basic principles in the management of such injuries.

Impalement brain injury: report of five consecutive clinical cases

“…1, 2 , 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 and 13). This is in tandem with the findings of previous earlier studies [4,7,14]. The aetiological factors identified in this report included assault, accidental Dane gun discharge, road traffic accidents and fall from a tree.…”

“…Penetrating brain injury caused by foreign objects is quite uncommon; this is attributed to the smaller size of the head compared to the rest of the body, in addition to protective reflexes in the face that allow the victim to move away from the injurious object [3][4][5]. Various types of impaled objects have been reported, including but not limited to nails, knives, spear, wooden chopstick, brush and screwdrivers [4,6,7]. Extraction of impaling objects at the site of injury is strongly discouraged because the outcome is better in a well-designed procedure in a neurosurgical theatre [8][9][10].…”