Management of Penetrating Pneumatic Nailgun Injuries of the Knee

Of 36 patients who presented over a 3-year period with nailgun injuries, nine of these injuries were found to have penetrated into the knee joint. Six of these injuries were treated by operative nail removal, curettage of the nail tract, and examination of the joint. The remaining three patients had nail removal, followed by irrigation of the joint in the emergency room. All nine injuries had antibiotic prophylaxis before and after nail removal. In three of six patients treated by operative irrigation and debridement, a piece of clothing or nailgun resin was discovered in the nail tract or floating within the knee joint. None of the patients in the group treated by operative nail removal, joint visualization, irrigation, and nail tract curettage experienced any complications, whereas one patient treated nonoperatively developed a septic knee. Due to the unique nature of these nailgun puncture wounds, we strongly advocate operative nail removal, curettage of the nail tract, visualization of the joint, and use of prophylactic antibiotics in the treatment of nailgun arthrotomies.