Impalement Injury by a Wooden Branch

Abstract

Case Study: We report the case of a 60-year-old male, who suffered an impalement injury by a wooden branch approximately 32 cm in length, when he fell from a tree. The pole penetrated the left proximal thigh dorsomedially, passed the inguinal ligament and went on through the preperitoneal space and the diaphragm into the thorax without injuring any organ. Directly after the accident, the patient went to the nearest emergency room. He had an approximately 6 cm long wound close to the ischiadic tubercle with no further signs of an incorporated foreign body and was in a stable general condition. Within the next hours, he developed pulmonary and circulatory insufficiency. Following enhanced diagnostics and secondary transfer to a trauma center, the foreign body, a wooden branch approximately 32 cm in length and 3 cm in diameter, could be surgically removed after 16 h. Discussion: The purpose of the presented paper is to discuss difficulties in the primary diagnosis of a major impalement injury which was misestimated by the patient's history, a stable general condition and only minor clinical signs at the entry portal and therefore mistaken for a "standard minor injury to the buttock".