Nail in leg

[gkiley1]

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I am a pre pharm student and had some questions about a recent accident of mine. I was hanging some crown molding and accidently put a nail in my leg with the nail gun I was using. The nail is about 1/16" in diameter is 11/4" long. I went to the ER and they told me that is was too deep for them to do anything there. They referred me to a surgeon that was going to remove it the next morning. When I called the surgeons office the next morning I realized that he was not a provider for my insurance. I then went to my Family Practice Dr. and he referred me to another surgeon. I met with the new surgeon today and after looking at my xray, he said I was better off leaving the nail in my leg. Prior to speaking with surgeon #2 I asked 4 other Dr.'s and they all said that it would need to come out. I have a feeling that surgeon #2 just didn't want to mess with it. I hear it's like trying to find a needle in a hay stack. I basically want to know if this Dr. was full of it or if it is really okay to leave it in there. It is quite painful to walk. Please advise.

 

[KevinEm]

I just want to tell you that you are clearly a brilliant person - trying to get medical advice on an anonymous email board from people who aren't even physicians yet (for the most part). On top of that, no one can see or examine you. Obviously you fell from the stupid tree, and I hope you didn't end up in the ugly bush. What a bright person you are! Perhaps you could get great input from your local CVS pharmacist? Anyway, seriously, I would advise you to take a swiss-army knife, bite the bullet Rambo style, and carve the mutha out yourself. Save money, no insurance hassle, plus in the end, you would be one tough mutha.

 

[beanbean]

gkiley1,

Ouch, that must have hurt! If you don't feel comfortable with the advice the surgeon gave you, by all means get a second opinion. It is not appropriate for people on SDN can not give you medical advice online.

KevinEM - there is no need to be rude and insulting to other posters on this forum.

 

[Apollyon]

I just want to tell you that you are clearly a brilliant person - trying to get medical advice on an anonymous email board from people who aren't even physicians yet (for the most part). On top of that, no one can see or examine you. Obviously you fell from the stupid tree, and I hope you didn't end up in the ugly bush. What a bright person you are! Perhaps you could get great input from your local CVS pharmacist? Anyway, seriously, I would advise you to take a swiss-army knife, bite the bullet Rambo style, and carve the mutha out yourself. Save money, no insurance hassle, plus in the end, you would be one tough mutha.

Did this thread get moved to this forum from elsewhere? Here in the EM forum, 1. we're civil (unlike your post), and 2. we're mostly doctors.

To the OP - normal advice is "see your doctor". Without examining you, in general, not specifically for you - foreign bodies can be left if there is no reason to take them out. Some reasons to come out are: infection, disruption of structures (blood vessels, lymph vessels, nerves, muscles, bones, periostia, tendons/ligaments), or if the patient is unable to participate in daily activities (pain, cosmetic, etc).

 

[gkiley1]

I just want to tell you that you are clearly a brilliant person - trying to get medical advice on an anonymous email board from people who aren't even physicians yet (for the most part). On top of that, no one can see or examine you. Obviously you fell from the stupid tree, and I hope you didn't end up in the ugly bush. What a bright person you are! Perhaps you could get great input from your local CVS pharmacist? Anyway, seriously, I would advise you to take a swiss-army knife, bite the bullet Rambo style, and carve the mutha out yourself. Save money, no insurance hassle, plus in the end, you would be one tough mutha.

Thanks KevinEm!

 

[Sheerstress]

gkiley1:

Did the surgeon say that he expected the nail to come out on its own? If so, did he say what to watch for? Were you given a tetanus booster? Or instructions on how to watch for a wound infection?

It's good that you've tried to get other opinions on your injury, because wound infections are serious problems in emergency medicine. However, here on an internet forum, we do not have all the needed information on your condition to make an acurate recommendation.

I would call back your family physician, tell him you want a second opinion from another surgeon, and make sure it's someone who's good. You don't want to take a chance on this turning into something bad.

 

[beanbean]

Did this thread get moved to this forum from elsewhere? Here in the EM forum, 1. we're civil (unlike your post), and 2. we're mostly doctors

I don't think the thread was moved. KevinEM has posted in the interview thread.

Seriously Kevin, there was no need to post such a nasty response to a pre-pharm student asking for some advice.

 

[gkiley1]

gkiley1:

Did the surgeon say that he expected the nail to come out on its own? If so, did he say what to watch for? Were you given a tetanus booster? Or instructions on how to watch for a wound infection?

It's good that you've tried to get other opinions on your injury, because wound infections are serious problems in emergency medicine. However, here on an internet forum, we do not have all the needed information on your condition to make an acurate recommendation.

I would call back your family physician, tell him you want a second opinion from another surgeon, and make sure it's someone who's good. You don't want to take a chance on this turning into something bad.

He said wait 4-6 weeks and if it still hurts he will take it out. I have a friend that is an obgyn and he said it needs to come out now. I does bother me that I have this nail just hanging out in my leg. But thanks for the advice.

 

[A little elf]

Without seeing the injury, I would probably guess that a dirty nail that is stuck in your leg should probably come out. You should probably get a second opinion

 

[Celiac Plexus]

to the op-

std. disclaimer - Nothing I write should be contrued as valid medical advice....

But:

If you're concerned enough, or it's hurting you, go find another surgeon.

I don't think having a nail a nail in your leg is an emergency though. Unless it's infected, compromising blood vessels/nerves, or restricting movement, or causing persistent pain.

People get shot and walk around with bullet fragments in their bodies for the rest of their lives.

 

[gkiley1]

I am a pre pharm student and had some questions about a recent accident of mine. I was hanging some crown molding and accidently put a nail in my leg with the nail gun I was using. The nail is about 1/16" in diameter is 11/4" long. I went to the ER and they told me that is was too deep for them to do anything there. They referred me to a surgeon that was going to remove it the next morning. When I called the surgeons office the next morning I realized that he was not a provider for my insurance. I then went to my Family Practice Dr. and he referred me to another surgeon. I met with the new surgeon today and after looking at my xray, he said I was better off leaving the nail in my leg. Prior to speaking with surgeon #2 I asked 4 other Dr.'s and they all said that it would need to come out. I have a feeling that surgeon #2 just didn't want to mess with it. I hear it's like trying to find a needle in a hay stack. I basically want to know if this Dr. was full of it or if it is really okay to leave it in there. It is quite painful to walk. Please advise.

I was referred to another surgeon and he took it out yesterday. He said it was a good thing that I did because it was pointed right at an artery. Thanks for all the positive advice.

 

[Febrifuge]

Glad to hear it turned out well.

I wonder, would there be any benefit in sending a note or making a call to the surgeon who said to leave it in? Not as a "you bonehead!" but as a "hey, just so you know, I was not cool with your idea and neither was another surgeon."

Or is that just not the way it works?

 

[Handyman2Doc]

I can sympathize with your position, gkiley1. I am working my way through undergrad by framing houses. I guess I could qualify as a multiple (nail)gun shot victim. 😳 My most interesting incident was when a 3 1/4" 16d nail ricocheted off of another nail head and imbeded itself approximately 2" into the center of my sternum. Fortunately, I had a recent tetinus booster, so I just pulled it out (needed some sturdy pliers to do so) and kept on working. Such is the life of a framer. 🙄

I saw another interesting "nail" incident on Trauma ER a while back. A 50+ year old man came to the ER suffering from head aches and dizziness. A CT scan revealed a 3 1/4" framing nail situated dead center in his brain. When asked how this could be possible, the man said that 20+ years earlier he had been using a framing nailer and suddenly found himself lying on his back with a small trickle of blood coming from just above his tear duct and a "mild" head ache. Thinking the nail had merely hit and not penitrated, he went back to work and suffered no obvious ill effects until shortly before he came to the ER. If I remember correctly, the docs left it in and treated him with pain meds.

 

[Sessamoid]

I saw another interesting "nail" incident on Trauma ER a while back. A 50+ year old man came to the ER suffering from head aches and dizziness. A CT scan revealed a 3 1/4" framing nail situated dead center in his brain. When asked how this could be possible, the man said that 20+ years earlier he had been using a framing nailer and suddenly found himself lying on his back with a small trickle of blood coming from just above his tear duct and a "mild" head ache. Thinking the nail had merely hit and not penitrated, he went back to work and suffered no obvious ill effects until shortly before he came to the ER. If I remember correctly, the docs left it in and treated him with pain meds.

Thank god they didn't do an MRI! 🙂

 

[Handyman2Doc]

Thank god they didn't do an MRI! 🙂

 

[Febrifuge]

My most interesting incident was when a 3 1/4" 16d nail ricocheted off of another nail head and imbeded itself approximately 2" into the center of my sternum. Fortunately, I had a recent tetinus booster, so I just pulled it out (needed some sturdy pliers to do so) and kept on working.

Call me crazy, but I seem to remember something in EMT class about some vaguely important stuff, two inches to the posterior of the center of the sternum.

The sternum is that bone in the middle of the rib cage, right? 😉

 

[Handyman2Doc]

Call me crazy, but I seem to remember something in EMT class about some vaguely important stuff, two inches to the posterior of the center of the sternum.

The sternum is that bone in the middle of the rib cage, right? 😉

Yes it is. 😛 I guess I should have added that I didn't get much sleep that night because every time I moved it hurt like hell. It was pretty painful for about a week and was still sensitive to pressure for about four weeks. I have broken many bones as a result of sports, motorcycles and being a goofy kid. The pain was comperable to a broken leg or arm, but fortunately, if you are real careful you can do quite a bit without having to use your pecs. 😀