Cranial Impalement of a Falling Fence Spike in a Child: A Case Report

Cranial impalement injuries are rare. They occur from a variety of objects, and via different mechanisms. We describe the case of a 5-year old boy who suffered cranial impalement injury via a unique mechanism. He presented to our centre with an impacted 17.8cm long metallic rod (a fence spike) in the vertex of his cranium, just off the midline. The spike penetrated his head and broke off its supporting frame as the frame was falling off a collapsing brick fence. He was transported as soon as possible to the hospital by relatives, without any attempt to remove the impaled spike. An urgent cranial computerized tomogram was done, and the object was removed under general anaesthesia in the operating theatre. The patient had complete recovery and was subsequently discharged from the hospital, with no residual neurological deficit. This case demonstrates a rare mechanism of cranial impalement. It also highlights the importance of following basic principles in the management of such injuries.