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- Greg Baldwin, MD*
- Margaret Colbourne, MD†
- *Clinical Associate Professor of Pediatrics; Acting Head, Emergency Department.
- †Clinical Assistant Professor; Attending Physician, Emergency Department. University of British Columbia and British Columbia’s Children’s Hospital, Vancouver, BC, Canada.
OBJECTIVES
After completing this article, readers should be able to:
List causes of wound infection resistant to antibiotic therapy.
Describe appropriate management of puncture wounds.
Determine the correct diagnosis of persistent symptoms in children who have plantar puncture wounds.
Introduction
Puncture wounds are a common and usually innocuous form of minor trauma in children. In selected cases, especially those involving the plantar surface of the foot, serious complications can arise. The focus of this article is a practical approach to puncture wounds in general and plantar wounds in particular. Wounds involving the chest, abdomen, neck, and eye are potentially serious forms of penetrating trauma and, therefore, are beyond the scope of this article.
Epidemiology
Puncture wounds account for 3% to 5% of all traumatic injuries presenting to pediatric emergency departments and are more common in summer months. The majority (>50%) involve the plantar surface of the foot. Other common sites include the legs (especially the knees), arms, hands, and less commonly, the trunk and head. Plantar puncture wounds commonly are caused by nails (>90%), although wood, metal, plastic, and glass are relatively common causes of puncture wounds in the foot and elsewhere.
Pathogenesis
Most puncture wounds occur as isolated minor events in a child’s life; generally, medical care is not sought and there are no complications. Depth of wound penetration is the single most important factor in early uncomplicated healing, with superficial wounds doing well. Other factors that are important in outcome include wound location, the type of penetrating object, and whether the penetrating object has broken, resulting in a retained foreign body. Missed foreign bodies are a frequent cause of wound infection that is resistant to antibiotic therapy. Rarely, puncture wounds that involve the limbs may injure nerves, blood vessels, or tendons, leading to compromise …
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