Article Text

PDF

Fishing penetration injuries
  1. I Dudkiewicz,
  2. M Salai,
  3. A Blankstein,
  4. A Chechik
  1. Department of Orthopedics, Sheba Medical Center, Tel-hashomer, and the Sacler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
  1. Correspondence to: Dr I Dudkiewicz, Department of Orthopedics, Sheba Medical Center, Tel-hashomer 52621, Israel DUDKE{at}NETVISION.NET.IL

Abstract

Background—Fishing involves millions of people throughout the world and is considered a pleasant and harmless sport. However, many kinds of injury can occur. Penetrating injuries to the extremities by fishing equipment such as hooks and harpoons, and even by scales, or infection from penetration of scales etc are relatively common although hardly ever reported in the literature.

Methods—Illustrative cases of penetrating fishing injuries are presented and discussed, with suggestions for the recommended management of these types of injury.

Results—Most of these objects are designed to catch and hold resisting fish, so are usually sharp and narrow in the front and wider in the rear with or without spurs. Because of their very irregular shape, simple extraction by pulling is not recommended, because further damage may occur.

Conclusions—The use of the appropriate imaging modalities, a full knowledge of the contours of the object, and careful preplanning of the method of treatment are very important.

  • fishing
  • penetration injuries
  • extraction
  • imaging modalities

Statistics from Altmetric.com

Take home message

Fishing is a very common sport throughout the world and it can involve many kinds of injury, especially penetrating injuries. Doctors should be alert to the potential problems of extracting irregularly shaped objects such as hooks, harpoons, and scales. The use of appropriate imaging modalities, a full knowledge of the contours of the object, and careful preplanning of the method of treatment are very important.

There are two main aspects of fishing related injuries. One is the “mechanical” aspect, caused by penetrating foreign bodies; this is discussed in this paper. The other is infection. Although fishing injury related infections are quite common and usually trivial, they can cause severe damage1,2 and even death.3 This paper deals mainly with the “mechanical” nature of the injuries; discussions on infections deriving from them can be found in the appropriate literature.

Injuries caused by penetration of foreign bodies such as hooks, harpoons, special fishing knives, and even scales are relatively common in fishing, both professional and amateur.4–8 Most of these objects are designed to catch and hold resisting fish and are therefore usually sharp and narrow in the front and wider in the rear with or without spurs. Because of their very irregular shape, simple extraction by pulling is not recommended, because further damage may occur. We present illustrative cases of such injuries from a group of patients treated during 1995–1997, and also suggest an appropriate clinical approach.

Materials and methods

During 1995–1997, 300 patients with penetrating injuries were treated in our emergency department. The causes of the injuries were as follows: 169 were due to work accidents, 53 to road accidents, 45 to domestic accidents, and 33 to fishing. Of the patients with fishing related injuries, 24 were men. Their ages ranged from 7 to 81: 13 were in the 6–20 year age group, 15 in the 20–40 year age group, and five were older than 40. The injuries were mostly located in the extremities but also in the trunk. They were mainly inflicted by hooks of various size, but two were caused by harpoons and one by small scales.

All patients were treated under local anaesthesia in the emergency room, except one who needed treatment under general anaesthesia in the operating theatre.

All patients received antibiotic after removal of the object, usually amoxicillin/clavulunate 500/125 mg (Augmentin) three times a day, and also toxoid tetanus booster.

Illustrative cases

(1) A young man with a large fishing rod hook penetrating his foot. On examining another hook from the outside, it was clear from the spurs that had not penetrated that it could not simply be extracted by pulling. An x ray photograph of the foot (fig 1) confirmed the irregularity of the object. The hook was removed by using it as a hinge, making a local cut above its end, and pushing it forward while rotating it so as to avoid any additional tearing of soft tissue.

Figure 1

Large fishing rod hook penetrating the foot.

(2) A 17 year old girl who had been hit in the arm with a large fishing spear shot from a fishing gun which was stuck in the soft tissue of the distal arm with no apparent neurovascular damage (fig 2). Owing to its location, large size, and potential to damage vulnerable adjacent neurovascular structures, the spear was extracted in the operating theatre after surgical exposure by pushing it forward in the direction of the initial entry under direct vision. Thus less damage was inflicted on the surrounding tissue. The patient made an uneventful recovery and resumed physical activity.

Figure 2

Large fishing spear lodged in the soft tissue of the distal arm.

Discussion

Fishing is a sport enjoyed by millions of people throughout the world. It involves all age groups, and does not require special training or fancy equipment. However, as in most sports, injuries caused by falls, shoulder injuries, and especially penetrating injuries can occur. During routine emergency work, injuries caused by penetration of foreign objects are commonly encountered.

Many reports in the orthopaedic literature, as well as in other fields of medicine and traumatology, have discussed the treatment of foreign bodies, but very few refer particularly to penetrating fishing injuries in the extremities.4 More is written about eye injuries, perhaps because of the potentially devastating consequences of such an injury, although even an orthopaedic injury that is considered trivial and simple can cause severe incapacitating damage if treated incorrectly.5–8 In most instances when the foreign object involved is sharp, with smooth edges and uniform or unchanging contours (such as needles and small headed nails), its extraction is relatively simple. In particular, when one end of the object protrudes outside the extremity, the entire object may be pulled out manually or by using an instrument with a firm grip.

When the shape of the object involved is not uniform, such as most fishing rod hooks, harpoons, and spears, further information on its exact shape and location is of utmost importance when planning how to extract it. As most of these objects are metal, simple radiographs are adequate for this purpose. Other imaging modalities such as ultrasound or computed tomography should be used for unclear objects.9–14

Most penetrating objects can be extracted under local anaesthesia in the emergency department. When neural or vascular damage is a possibility or actually present on admission, safe extraction requires general or regional anaesthesia, widening of the penetrating wound, and careful exploration of the object tract to prevent further damage to neurovascular structures.

The above are just a few examples illustrating the importance of using appropriate imaging modalities to obtain a full knowledge of the contours of the object and careful advanced planning of the method of extraction.

These guidelines are put forward to alert doctors to the potential problems of common fishing injuries caused by irregularly shaped penetrating objects and to prevent the possible additional damage that can be caused when they are simply pulled out by inexperienced practitioners.

This paper deals only with penetration injuries. As fishing is such a popular sport, more studies are required to evaluate the exact extent of all other types of fishing injury.

Take home message

Fishing is a very common sport throughout the world and it can involve many kinds of injury, especially penetrating injuries. Doctors should be alert to the potential problems of extracting irregularly shaped objects such as hooks, harpoons, and scales. The use of appropriate imaging modalities, a full knowledge of the contours of the object, and careful preplanning of the method of treatment are very important.

References

View Abstract

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.