Penetrating nail gun injuries: Role of antibiotics and surgical management

Introduction Penetrating nail gun injuries are a common presentation to Australian Emergency Departments (EDs). Despite a paucity of evidence, routine surgical debridement and intravenous antibiotics are the current practice to prevent subsequent infection. We aim to provide evidence on the efficacy of surgical debridement and antibiotics in preventing infection following a penetrating nail gun injury. Methods A retrospective study was conducted, that included all patients who presented to The Alfred between 2012 and 2020 with penetrating nail gun injuries. Patients were sub-grouped into those managed with surgical intervention at the time of the presentation and those who were not. Patients who were managed without initial surgical intervention were further sub-grouped to those given prophylactic antibiotics or not. The primary outcome was wound infection at 30 days post injury. Results There were 157 patients included of which 43 (27.4%) patients underwent surgical debridement. There was no statistical difference in rates of infection between the non-surgical versus surgical management groups (2.6% vs 0%, p = .78). Among those who did not undergo formal surgical debridement, there was also no significant association between prophylactic antibiotics and infection (OR 0.25; 95% CI: 0.21–2.81). Conclusion Blanket operative debridement and prolonged antibiotics for penetrating nail gun injuries may not be necessary to prevent subsequent infection. The interventions should be tailored for specific indications.