Upper Limb Impalement Injury Caused by a Metallic Gate Rod with Preservation of Major Neurovascular Structures: A Case Report
Kewecho Akami
*
Department of General Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India.
Nyemwang W. Konyak
Department of General Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India.
Ranendra Hajong
Department of General Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India.
Noor Topno
Department of General Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India.
Arup J. Baruah
Department of General Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India.
Hano Tara
Department of General Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India.
*Author to whom correspondence should be addressed.
Abstract
Aims: To describe the clinical assessment, imaging findings, operative management and early outcome of an upper-limb impalement injury caused by a metallic gate rod, with emphasis on neurovascular evaluation and controlled extraction.
Presentation of Case: A 46-year-old man presented after falling onto a pointed metallic gate, resulting in a transfixing injury of the right arm. The projecting rod was shortened for transport, but the embedded portion remained in situ. The patient was haemodynamically stable, with preserved distal perfusion, motor function and sensation. Radiography demonstrated the retained metallic object without fracture or joint involvement. CT angiography showed maintained brachial arterial continuity without evidence of extravasation, occlusion, pseudoaneurysm or arteriovenous fistula, although metallic artefact limited assessment of adjacent structures. Emergency operative exploration identified a trajectory through the posterior muscular compartment. The brachial vessels, radial, median and ulnar nerves, and major musculotendinous structures were intact. The rod was removed under direct vision, followed by debridement, irrigation and layered closure. A separate anterior shoulder laceration was also treated surgically.
Discussion: This case illustrates the value of combining clinical neurovascular examination, appropriately selected imaging and direct operative inspection when managing penetrating injuries close to major vessels and nerves. Artefact from retained metal may restrict local interpretation of CT angiography.
Conclusion: The postoperative course was uncomplicated, with healed wounds and preserved upper-limb function at four weeks. The single-patient observation and short follow-up limit conclusions about longer-term outcomes.
Keywords: Impalement injury, upper limb trauma, penetrating trauma, computed tomography angiography, neurovascular preservation, extremity trauma