A 42 year old man comes to clinic saying he has a fish hook stuck in his finger. He was fishing that morning and when he was baiting the hook, the hook slipped and entered his left middle finger. He tried to pull it out but couldn’t because the end has a barb on it. He denied any significant bleeding. He can’t remember the date of his last tetanus shot. “It’s been awhile.”
On exam, there is a 5-6 cm metal hook embedded at the end of the patient’s left middle finger. There is no active bleeding. The tip of the nail is not visible.
This is certainly not the first patient who has presented to an urgent care clinic for a fish hook accident. It actually happens more often than one might think. The challenge is removing the fish hook with minimal damage to the finger. It is usually unwise to try to pull the hook out by the shaft because the barb can tear surrounding tissues on its way out. Therefore it is often easier to push the hook completely through the other end, and then using a special instrument, snip off the barb. The hook can then be safely pulled out by the shaft.
Anytime someone has trauma that breaks the skin, it is also important to make sure they have received a tetanus booster within the past 5 to 10 years.
The patient’s finger we anesthetized with lidocaine using a small needle. Once the finger was completely numb, the fish hook was gently pushed through the tip of the finger until the barb exited the skin. Using fish hook shears, the barb was snipped off and the fish hook was easily removed. There was very little bleeding. His finger was bandaged with antibiotic ointment, and he was given a tetanus booster. He was seen for a recheck two days later and his finger was healing nicely with no signs of infection.
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