Penetrating skull injury with six inch fence rod
A 10-year-old male child was playing with his siblings on the terrace of his house from two floors height. He slipped off the terrace while playing and landed head-on on the fence of his house and tumbling down onto the ground unconscious with an impacted broken distal end of the fence in the parietal bone []. There were no seizure episodes.\nOn examination in the emergency room, he was conscious, cardiovascularly stable, maintaining his airway adequately with no major hemorrhage and secretion pouring through the penetration site. His vitals were stable (pulse rate: 100/min, blood pressure 102/64 mm Hg, and respiratory rate 18/min). Neurologically, his Glasgow coma score (GCS) was 10/15 – E2M3V5. His left pupil was dilated and the fractured end of the fence was seen jutting out through the scalp. Patient had an episode of nausea and vomiting. There was peroral and pernasal bleed. There were no other injuries apart from few bruises. CT scan showed a spear-like radio-opaque object penetrating the mid-parietal bone and entering the structures below to end just above the palate [Figures and ].