Impalement head injuries

Introduction

Forceful penetration of the head by a sharp foreign object causing an injury to the cranial-facial-cervical region is one of the many definitions of impalement head injuries found in many dictionaries. The impaling object is usually embedded in the cranial-facial-cervical region of the head1^-4; in a few patients a part of the impaling object can pierce through the opposite side3. Impalement can be accidental, as a result assault or deliberate5. Many more impalement head injuries are now seen throughout the world where violence, sectarian conflicts and wars are rife.

The urge to quickly and safely remove the impaling object at the scene must be strongly resisted, because outcome is much better in a planned procedure in a surgical theatre2,3,4. Prompt extraction of the impaled patient with the impaling object in situ without attempting to retrieve the object after adequate resuscitation of the impaled patient at the scene of the accident are essential to a good outcome2,3,4. Prompt transfer to a medical facility where diagnostic computerized tomographic imaging^3,4 of the trajectory of the impaling object can be done to facilitate the safe retrieval of the object by the neurosurgeon and a multidisciplinary team of experts, who will not cause more damage to contiguous structures already damaged by the primary impaling object2,3,4.

Surgical principles of management of a compound head injured patient with control of raised intracranial pressure, haemorrhage; adequate oxygenation and airway care are applied. Careful debridement of the wound, judicious use of antibiotics and anti convulsant therapy are needed. The outcome is usually good in these patients depending on the primary damage inflicted by the impaling object, which is best left in situ, until patient is in theatre, intubated and draped for the surgical procedure3,4. Adequate resuscitation, radiological imaging and adherence to the principles of surgical management are applied.

A fully equipped ambulance with trained personnel who can safely retrieve the patient with the impaling object in situ, initiate and maintain resuscitation to the specialized medical facility where brain and cervical CT scan and surgical intervention can be done. Post operative care can be continued in the intensive care or high dependency facility. Early rehabiltation will also aid excellent outcome.