• Victoria Teoh and Zakir Shariff.
• Department of Plastic Surgery, Bradford Royal Infirmary, Bradford, UK.
• Emerg Med J. 2019 Feb 1; 36 (2): 65-71.

IntroductionThis case involved a 15-year-old boy, who slipped and impaled his left hand on a wooden beam. An initial anterior-posterior radiograph was obtained prior to referral to plastic surgery for further management (figure 1).emermed;36/2/65/F1F1F1Figure 1Clinical photographs and initial X-ray taken of the impalement injury.Clinical examination was restricted due to access. The patient reported general pain on limited movement of all digits but normal neurology. He received appropriate initial treatment of broad-spectrum antibiotics and tetanus care in the emergency department. His medical and social history were unremarkable.QuestionWhat is the next most appropriate intervention?Immediate removal of the impaled structure under tourniquet control in an operating theatre.Immediate removal of the impaled structure in the emergency department under nerve block.Further imaging is needed.Urgent surgical consultation.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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