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Nail Gun Injuries


Michael I. Greenberg

, MD, Drexel University College of Medicine;

David Vearrier

, MD, MPH, University of Mississippi Medical Center

Reviewed/Revised Aug 2022 | Modified Sep 2022

Nail gun injuries are usually puncture wounds on the hands and fingers, but sometimes they cause more serious injuries.

Nail guns injuries are common among construction workers. Nail guns, which have replaced hammers in wood-frame construction, cause an estimated 37,000 emergency department visits each year. About 60% of them are work-related.

Nail guns deliver nails under very high pressure. Most nail gun injuries involve the fingers and hand. However, injuries to the legs, trunk, eyes, and head can also occur. If the eyes are injured, vision may be lost.

In addition to the nail, other materials (foreign objects such as wire, fabric, paper, and adhesives) can enter the wound during a nail gun injury and lead to infection.

Nails and foreign objects may be embedded in soft tissues, including nerves, tendons, blood vessels, or joints or in bone.

Using a nail gun with a bump or automatic trigger can result in unintended nail discharge. Using a nail gun with a single shot or full sequential trigger reduces the risk of injury. Risk can also be reduced by learning how to use nail guns correctly and what the potentially devastating effects of nail gun injuries are. Employers should provide such training for their workers.

Evaluation of Nail Gun Injuries

If a person has a nail gun injury, first aid First-Aid Treatment Cuts or tears in tissue (lacerations), scrapes (abrasions), and puncture wounds can be caused by bites or by other mechanisms. Wounds that are not caused by bites and are clean and relatively... read more should be done and medical attention should be sought immediately, even if the injury seems insignificant. First aid includes applying pressure on the wound with a clean cloth if the wound is bleeding and elevating the injured limb above heart level. The person should not try to remove the nail.

Doctors evaluate nail gun injuries by doing the following:

  • Identifying (and treating) serious injuries

  • Controlling bleeding if needed

  • Checking for damage to structures under the nail gun wound

The nail is typically embedded in the wound when people come to the emergency department or doctor's office.

If wounds are bleeding, the bleeding must be stopped before evaluation. Doctors apply direct pressure to the wound and, when possible, elevate the affected part. Anesthetics that contain epinephrine, applied to the wound, may also help reduce bleeding. A tourniquet may be applied above the wound. It may make it easier to examine hand and finger wounds.

Doctors thoroughly check for damage to structures under the injury, including nerves, tendons, blood vessels, joints, and bones. They also take x-rays to check for bone damage and to determine the general location and type of nail. The type of nail affects how the nail should be removed. For example, nails with barbs are more difficult to remove and are removed in the operating room.

X-rays can also help doctors locate any foreign objects present.

Evaluation by a specialist may be needed. For example, if the eye is injured, an ophthalmologist is consulted as soon as possible.

Treatment of Nail Gun Injuries

Treating nail gun injuries involves

  • Removal of the nail

  • Wound care

If nails are embedded in soft tissue and no structures are damaged, doctors apply an anesthetic to the affected area and remove them by pulling. The wound Wounds Cuts or tears in tissue (lacerations), scrapes (abrasions), and puncture wounds can be caused by bites or by other mechanisms. Wounds that are not caused by bites and are clean and relatively... read more is then cleaned and flushed (irrigated) with water or a saline solution, and a sterile dressing is applied.

For all other nail gun injuries, surgery is done to examine the injury, and the nail is removed in the operating room.

Nail gun injuries are typically deep puncture injuries and thus are allowed to heal without being stitched up.

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