DESCRIPTIONA puncture wound is produced by any object that penetrates the skin to the soft tissue, bones, or joints below. Puncture wounds are likely to be full of dirt and should cause immediate concern because of the danger of tetanus. Tetanus is an extremely serious infection, caused by a poison secreted by tetanus bacteria. These are found in soil, particularly soil contaminated by animal droppings. The toxin from the bacteria spreads through the bloodstream and sets off muscle spasms throughout the body that produce the characteristic locked jaw. Tetanus bacteria thrive on low concentrations of oxygen, exactly the condition that exists in a sealed-over puncture wound.
Appropriate health care includes:
Self care for minor wounds if tetanus boosters are current (if in doubt--call your doctor).
Physician's treatment for a serious wound to clean the wound and sometimes to explore it surgically to determine the extent of the damage.
SIGNS & SYMPTOMS
A hole in the child's skin with a puckered and discolored edge. The hole may appear smaller than the object that caused it, due to partial re-expansion of the damaged tissues.
Any foreign body that penetrates the child's skin and underlying tissue (cleats, javelin, splinters, glass).
RISK FACTORSContact sports.
Activities on rough terrain.
Stepping on rusty nails.
PREVENTING COMPLICATIONS OR RECURRENCE
A baby should receive a series of tetanus inoculations before 1 year, a booster shot at 1-1/2 years, and another booster before entering school. To keep the immunization to tetanus effective, everyone--children and adults -- should have a tetanus booster shot every 10 years. Record the dates of the shots and take them with you whenever your child needs emergency treatment. In general, if your child has had the basic 4 tetanus immunizations or a booster injection within the past 5 years, it may not be necessary to have another booster after a puncture wound.
Your own observation of symptoms.
Medical history and physical exam by a doctor.
Culture of the wound.
X-rays of underlying tissue to rule out fractures and joint damage.
Fluid collection under a closed penetrating wound.
With treatment, a child's puncture wound usually heals without complications.
Remove any foreign material (splinter, glass, or others) if you can.
Clean the area of the child's wound with warm water and soap.
Extensive or deep penetrating wounds may need to be enlarged and explored surgically under antiseptic conditions.
If bleeding occurs, control it by applying firm pressure to the child's wound with a cloth.
Use warm immersion soaks to relieve the child's pain and swelling. Use plain warm water or warm water with Epsom salt or table salt (4 tablespoons to 1 quart of water).
Your child should rest the injured part until it heals and should wear a snug elastic bandage over the injured area, if possible. This will decrease fluid collection under the child's wound and minimize further bleeding.
Get a tetanus booster shot for your child, if needed.
Keep the injured part elevated when possible; for example, prop an injured foot on a footstool while the child is sitting, or on a pillow while sleeping.
MEDICATIONFor minor discomfort, use non-prescription drugs such as acetaminophen.
Your doctor may prescribe antibiotics to fight infection or a tetanus booster, if needed.
Your child can resume normal activity slowly after clearance by your doctor.
DIET & FLUIDS
For a serious puncture wound, your child should eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk, and eggs.
OK TO GO TO SCHOOL?Yes, if there are no signs of infection.
CALL YOUR DOCTOR IF
Your child receives a puncture wound and has not had a tetanus booster in 10 years.
Signs of a wound infection (fever, headache, or increasing pain, redness, and fluid with pus at the puncture site) develop.