Neck Impalement during Mountain Biking
A previously well 40-year-old man was riding a mountain bike off-road when he fell and impaled his neck on a branch that was 2 cm in diameter. The patient did not attempt to remove the branch, and he transported himself to our emergency department. A computed tomographic angiogram showed the foreign body in the soft tissues of the left side of the neck at the level of the superior thyroid cartilage, extending through the platysma muscle, to the anterior margin of the sternocleidomastoid muscle (Panel A, arrow). The branch extended approximately 1.6 cm deep into the neck from the skin surface, with no evidence of vascular or airway injury (Panel A). Penetrating neck injuries can be associated with vascular, airway, cervical spine, or nerve injuries. The foreign body may be providing tamponade if a major vascular structure is injured; hence, there is a possible benefit to leaving the foreign body in place until radiologic and surgical evaluations are performed. In the operating room, the foreign body (Panel B) was removed, and the wound was explored, irrigated, and closed. The patient had an uneventful postoperative course.
