Caribbean Medical Journal (Jun 2023)
Risk factors and complications of nail-stick plantar injuries in Jamaican children
Abstract
Objectives: To determine the prevalence of nail-stick foot injuries in children visiting the Bustamante Hospital for Children (BHC) in Jamaica, identify the time between injury and hospital presentation, identify the risk factors for injury and complications, identify the complications, and the association between time to presentation and complication rate. Method: A retrospective cohort analysis of children between the ages of 0-12 years presenting to the BHC from July 1, 2015, to August 31, 2018, with nail-stick foot injuries was performed. Extracted data included demographics, date of injury and presentation, side injured, zone of injury, number of nail-sticks, footwear use during injury, treatment, date of hospital discharge and complications. Data were analysed to determine the factors associated with morbidity including complications. Results: Two hundred and ten (210) children met the inclusion criteria. The prevalence rate was 6 patients per 1000 hospital admissions. The mean time to presentation was 2 days. Using Patzakis classification, 26, 76 and 66 persons had zone 1, 2 and 3 injuries respectively. The complication rate was 14.8%. Complications observed were abscesses (77.4%), retained foreign bodies (9.7%), osteomyelitis (6.5%), deep wound infection (3.2%) and cellulitis (3.2%). Children presenting after 2 days (p<0.0001) and zone 1 injuries (p=0.030) were more likely to have complications. Footwear was protective against complications (p=0.006). Conclusion: Nail-stick foot injuries are frequent presentations at the Bustamante Hospital for Children. Boys older than 9 years are the greatest at-risk group. The most common complication is abscess formation and delays in presentation greater than 2 days were more likely associated with complications.
