Correct!
The answer is c. Removal of the impaled structure in a controlled environment and subsequent surgical debridement are important principles in the management of impalement injuries, particularly if there is gross contamination.
However, the most appropriate initial management in this case would be to obtain further imaging. Information from a lateral view on plain radiograph would clarify the extent of the impalement and potential anatomical structures involved prior to embarking on a surgical procedure.
In this case, the lateral radiograph demonstrates that all, but one, of the nails are a ‘red herring’ and embedded in the wood. A solitary nail is impaling the radial aspect of the thumb, at the level of the metacarpophalangeal joint, in the subcutaneous plane.
The principle that a minimum of two radiographic views, which must include a posterior–anterior and lateral image, is fundamental to the initial management of hand injuries.
The lateral radiographic view provides spatial information and aids in building a three-dimensional image to facilitate diagnosis and management of hand injuries.
This can be particularly important in hand fracture management.