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Anteroposterior, lateral and tangential view skull radiographs showing penetrating injury caused by three-pin plug and an underlying depressed skull fracture.
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... Several materials have been reported as PBI [1,2,[12][13][14][15][16][17][18][19][4][5][6][7][8][9][10][11], but little is known about penetrating pickaxe and its surgical management challenges. Herein, we report PBI by a pickaxe in a 13-year-old child and discuss the challenges encountered in its surgical extraction and postoperative management. ...
... Fortunately, Brazil has effective public prehospital trauma care that was certainly the watershed between life and death in this case. Foreign body removal at the scene was not recommended because it could reduce pressure on vascular structures, inducing hemorrhage [11]. ...
Head trauma due to falls is often seen in children, however Penetrating Brain Injury (PBI) – the most life-threatening condition of Traumatic Brain Injury (TBI) - is exceedingly rare. Herein, we report and discuss the challenges encountered in surgical and post-operative management of a 13-old-child patient with PBI by a pickaxe, admitted in Glasgow Coma Scale (GCS) 3 and that not only survived, but also achieved a Glasgow Outcome Scale (GOS) after one year of postoperative follow-up. To our knowledge, this is the first case of pickaxe-induced brain injury on the American Continent and the youngest survivor of this trauma reported in literature.
... Several materials have been reported as PBI [1,2,[12][13][14][15][16][17][18][19][4][5][6][7][8][9][10][11], but little is known about penetrating pickaxe and its surgical management challenges. Herein, we report PBI by a pickaxe in a 13-year-old child and discuss the challenges encountered in its surgical extraction and postoperative management. ...
... Fortunately, Brazil has effective public prehospital trauma care that was certainly the watershed between life and death in this case. Foreign body removal at the scene was not recommended because it could reduce pressure on vascular structures, inducing hemorrhage [11]. ...
Head trauma due to falls is often seen in children; however, penetrating brain injury (PBI), the most life-threatening condition of traumatic brain injury (TBI), is exceedingly rare. Herein, we report and discuss the challenges encountered in the surgical and postoperative management of a 13-year-old child patient with PBI by a pickaxe who was admitted to Glasgow Coma Scale (GCS) 3 and who not only survived but also achieved a good Glasgow Outcome Scale (GOS) after one year of postoperative follow-up. To our knowledge, this is the first case of pickaxe-induced brain injury on the American continent and the youngest survivor of this trauma reported in the literature.
... Early clinical diagnosis, urgent x-ray skull and CT brain is important for a favourable prognosis [4]. In the presence of an obvious penetrating injury with an imbedded foreign body, no attempt should be made to remove the object until the patient has had a thorough clinical and radiological evaluation [5]. MRI is contraindicated in penetration of metallic objects. ...
Traumatic Brain Injury is among the leading cause of morbidity and mortality in modern times. Data suggests that almost 50 % of all trauma related deaths are secondary to traumatic brain injuries (TBI). Penetrating head trauma by definition means a wound in which a projectile breaches cranium but does not exit it, such can result from accidental events like road traffic accidents, occupational accidents or even household accidents apart from homicidal or suicidal intentions. As such these are rare in paediatric age group. Here we report the case of a 4 year old male child with history of fall of a concrete slab over head with penetration of a wedge of concrete into skull and his miraculous survival.
... Rare injuries with fishing harpoon, electrical plug, metal rod, flying wire fragment, wheel of grinder tool, drill bit, nail or needle knife, pencil, lawn darts, toy, plastic hair beads, and screw driver have also been reported. [4][5][6][7][8][9][10][11][12][13][14][15] A new object, wooden shovel handle was reported in this paper. ...
... After clinical and radiological evaluation, attempt to remove the object should be done in the operating room. 5 Patients with transcranial injury should be evaluated with skull x-rays, CT and CT angiography. Accordingly, surgery was planned based on radiological studies in our patient. ...
Penetrating cranial injury is a potentially life-threatening condition. Shell and shrapnel fragments are the most common cause of high velocity penetrating head injuries. The pathophysiological consequences of penetrating head injuries depend on the kinetic energy and trajectory of the object. If the velocity of the penetrating object is high enough, the object shape and sharpness is not very important for penetrance. We reported a case of transcranial injury caused by a broken wooden shovel handle. The Glasgow Coma Scale score of the patient was 4 in the emergency department. Wooden shovel handle had entered through the right maxillary region, penetrated the brain and come out of the skull through the right parietal bone. Surgery was planned according to the radiological studies. Expeditious removal of the foreign body was carried out by craniotomy. The patient died on postoperative day 3. A number of high velocity transcranial injuries have been reported in the literature, but to the best of our knowledge, there was no report on transcranial injury with a wooden shovel handle.
... The most appropriate management in the fi eld is to leave the transcranial object in situ and transport the patient to the trauma center carefully. Tan and Choudhari [11] suggested that in the presence of an obvious penetrating injury with an imbedded foreign body, no att empt should be made to remove the object until the patient has had a thorough clinical and radiological evaluation. Sudden removal can cause loss of tamponade eff ect and subsequent catastrophic intracranial hemorrhage. ...
Penetrating cranial injury is a potentially life-threatening condition. Injuries resulting from the use of angle grinders are numerous and cause high-velocity penetrating cranial injuries. We present a series of two penetrating head injuries associated with improper use of angle grinder, which resulted in shattering of disc into high velocity missiles with reference to management and prevention. One of those hit on the forehead of the operator and the other on the occipital region of the co-worker at a distance of five meters. The pathophysiological consequence of penetrating head injuries depends on the kinetic energy and trajectory of the object. In the nearby healthcare center the impacted broken disc was removed without realising the consequences and the wound was packed. As the conscious level declined in both, they were referred. CT brain revealed fracture in skull and changes in the brain in both. Expeditious removal of the penetrating foreign body and focal debridement of the scalp, skull, dura, and involved parenchyma and Watertight dural closure were carried out. The most important thing is not to remove the impacted foreign body at the site of accident. Craniectomy around the foreign body, debridement and removal of foreign body without zigzag motion are needed. Removal should be done following original direction of projectile injury. The neurological sequelae following the non missile penetrating head injuries are determined by the severity and location of initial injury as well as the rapidity of the exploration and fastidious debridement.
... Tan and Choudhari recommended that in the presence of an obvious penetrating injury with an embedded foreign body, under no circumstances any attempt should be made to remove the object, until the patient had a thorough clinical and radiologic evaluation. 5 Sudden removal can cause loss of the tampon effect and subsequent catastrophic intracranial hemorrhage may happen. Removing the impacted object is best done in the operation room by a dedicated neurosurgical team. ...
Nonmissile low-velocity penetrating brain injuries are unusual among civilian population. Work-related penetrating head wounds are rarer among this group. Here, we report two rare cases of penetrating head wounds caused by industrial grinder tool. The patients (both men) were struck to the head by detached blades of the grinder tool. Depressed fractures, penetrated bone fragments, and dural lacerations were all treated by the routine fashion. Paranasal sinus damage and further cerebrospinal fluid leakage were also treated conservatively. The reported cases are unexpected variants of injuries that neurosurgeons may come across and their management is still beyond the scope of textbooks. Skill and experience of the general neurosurgeons can handle the cases properly but prevention of such incidents using safer and guarded instruments should be stressed to manufacturers.
... Craniofacial penetrating trauma by foreign objects represents a small fraction of traumatic brain injury in the pediatric age group (12). Children < 2-3 years of age falling onto blunt household items are at greater risk to sustain these types of injuries (13,14). In the world literature, other papers have presented cases in which a child's skull is penetrated by objects such as metal rods or wires, chopsticks, wooden branches, an electric plug, and glass (13,(15)(16)(17)(18)(19). ...
... Children < 2-3 years of age falling onto blunt household items are at greater risk to sustain these types of injuries (13,14). In the world literature, other papers have presented cases in which a child's skull is penetrated by objects such as metal rods or wires, chopsticks, wooden branches, an electric plug, and glass (13,(15)(16)(17)(18)(19). The skull of a young child is incompletely ossified until c. 2 years of age, so they are at greater risk for penetrating injury to the bone and dura caused by lowvelocity foreign objects (12)(13)(14). ...
... In the world literature, other papers have presented cases in which a child's skull is penetrated by objects such as metal rods or wires, chopsticks, wooden branches, an electric plug, and glass (13,(15)(16)(17)(18)(19). The skull of a young child is incompletely ossified until c. 2 years of age, so they are at greater risk for penetrating injury to the bone and dura caused by lowvelocity foreign objects (12)(13)(14). The maxillary sinuses, the ethomoid sinuses, and the orbits are at particular risk for penetrating injury, while the frontal and sphenoid sinuses are only occasionally involved (20). ...
Traumatic brain injury is the leading cause of morbidity and mortality among children suspected of child abuse. Penetrating cranio-facial injuries are generally rare in the pediatric age group and are caused by both accidental and inflicted mechanisms. We report an unusual case of a 2-year-old female who was admitted to a pediatric emergency room with an industrial stainless steel coat hanger impaled in her skull. Pertinent clinical forensic medicine examination, coupled with home inspection and interviews by the local law enforcement, revealed a horrible episode of domestic violence.
The authors report a fatal case of blunt trauma to the skull caused by a rib of a beach umbrella. The skull displayed a round hole in the right temporal bone with typical internal beveling. Blunt trauma mimicking a gunshot wound (round perforation of the skull with internal beveling) is very rarely reported in the forensic literature.
We present a case of penetrating trauma with a blunt object to the calvarium of a young child. Presentation, emergency room management, radiology, and surgical treatment are illustrated and discussed. It is of utmost importance in these cases to proceed in a way so as to minimize secondary injury that may be caused in removal of the foreign body.
Penetrating head injury is uncommon and is always a curiosity in terms of the mechanism involved. The complete extent of the damage can only be known with CT scan of the brain, which at times may be difficult to get, due to the large size of the foreign body. The management of such patients is always a challenge and requires innovative planning. A case of crochet needle injury is described in which the needle entered through the mouth and passed through the jugular foramen into the cerebellum. This patient, fortunately, escaped without any neurological deficit and complications. The principles of management are highlighted.
