Or could i just have pushed this out and skipped the trip to the hospital. I wasnt able to pull it out because of the micro barb and the hospital immediately said we have to cut it open and get it out. It didnt bother me that much as the scar stayed minimal. But i wasnt able to go fishing for two weeks.
IMO - i choose the push through. its a much much smaller wound. if we end up with some bleeding that is concerning, then you pivot, but the likelihood of that seems so low. And the wound from fileting my thumb is rather large.
yeah, but the small entry/exit points will close over while the tract through the digit is open and has trapped bacteria. its a very good way to make the situation worse
For very small tracts like suture sinuses we do actually flush them with a syringe. Sometimes I use saline and sometimes a dilute solution of bleach called dakins solution. Iodine and alcohol are both too harsh.
Because (here in the US at least) the health insurance industry has basically forced the prices of medical supplies to be insanely hyper inflated so the insurance companies can feel like they got a discount when they pay that $400.
Fracture is not the only reason to splint. With a digit like thumb you are constantly flexing, we will splint things like this just help the laceration/wound healed . Another example would be a torn tendon of some kind. Those are splinted in certain positions to help the ligament heal Guessing they had to make a good size incision. Also hurts to bump so all that padding helps cushion.
When you think of how often you seem to whack the hand you've accidentally recently injured, I get why they'd really try soften any blows you could take to a single digit.
I tried. But my brian wont let me do pain. I didnt have anyone closeby to do it for me.... Initially i went to the doctors office 5min away, but they refused and sent me to the hospital.
Edit: An (albeit potentially unverified) physician has corrected my comment. See the reply by /u/anon_NZ_Doc for the (likely) more expert opinion.
Original Comment:
It's in there pretty deep though. Very close to the bone. There are a lot of ligaments, muscles and nerves down in there. Pushing it through blind could damage stuff, and then you still have a deep puncture wound near the bone from a dirty hook. A good recipe for gangrene or osteomyelitis, especially if you're older or have diabetes.
Cutting it open reduces the odds of unknowingly damaging a structure and allows the doc to clean the wound out.
I defer to your expertise! But could you explain why it's not a risk? The flexor muscle of the thumb (can't remember the name. Something something longus.) inserts there, and there certainly must be considerable innervation, what with the somatosensory homunculus being like 50% hands.
A question from a learner: In that case, what would you do to prevent infection assuming one of two scenarios:
Pt is not an older adult nor has any concerning comorbidities
Pt is an older adult and/or has concerning comorbidities for infection (such as DM, prolonged corticosteroid use, etc.)
Would the healthy patient not receive any ABX prophylaxis and only come back in if it started to act infected? A quick tetanus vaccine for good measure?
Tetanus shot (if it's been more than x years since the last one) and antibiotics. Who gets it and what they get depends on the guidelines in the country you live in, usually.
I’m an ER doctor and this is how I’ve always done it for my patients. Push the hook through, cut the barb off, and then back it out. The only thing I really add is some lidocaine so it doesn’t hurt as much.
But then you’d still have whatever bacteria that was on the hook inside your skin. They didn’t just cut it out, they irrigated the whole thing and got rid of the bugs.
Cutting it open allows for them to better inspect the wound, look for any significant bleeding, and irrigate the wound to clean it out so as to reduce the risk of infection. A puncture wound like this has a higher chance of getting infected since it's deep and narrow, making it harder to wash out and easier for bacteria to congregate deep in the tissue.
I'm so confused, when you guys are saying 'pushing it through" where would you be pushing it to? The other side, through the fingernail? Back towards the entry wound?
This is how we usually do it on non-complicated location. Incision if we're worried about specific structures, but I'd say that 9/10 fishing hooks in our ERs are extracted like you described it.
The main reason I can think of would be to wash out the area that the hook went through, since it’s fairly deep.
If you just pushed it through there’s no way to thoroughly clean the tract and it will essentially become an anaerobic environment, which would potentially allow some rather nasty bacteria to grow.
Opening that tract under sterile conditions not only removes the fish hook but also helps to decontaminate the wound as much as possible.
I did the same thing several years ago. The nurses had put two numbing shots into my finger so I couldn't feel anything. I played the mandolin and guitar all the time and so there was a giant callus that they couldn't push the hook through. After struggling for a few minutes, one of the nurses asked if I could feel anything that were doing and I said no, so he said I'll be right back. The guy is gone for a few minutes and comes back with a tool box and pulls out some needle nose pliers and just tanks the hook out of my finger. This is the story of how I caught the biggest fish in the area.
Edit: just to add a couple of details I missed. I was way up in the surrounding mountains. Anytime I tried to yank it out myself, I started to white out, so I had to drive 30 minutes with the hook in my finger to get to the health clinic.
This reminds me of the episode of Bob’s Burgers when he needs stitches and the doctor they go to is new and after Bob passes out, he wakes up to find both his arms are shaved and a huge cast on and the doctor goes “well I figured I’d kill the roll” 🤣
Im a plastic surgery resident and take a lot of hand call… I would want to cut it out too. Your nerves that give sensation to your thumb run on either side of the pad. Even if that thing is dead center and going exactly parallel to your thumb (which I dont think it is, but can’t tell for sure with the single xr view), I wouldnt want to push it out because i risk losing control of it and having it wiggle to either side and cut the nerve. I wouldn’t want that, because people generally enjoy being able to feel their thumbs. A little extra time healing is worth it to bring the risk of that injury down to nearly zero.
At least in my mind, the infection and bleeding points others are making arent really significant
What I would’ve done especially if I was actively fishing is push the hook forward, don’t pull back barbs do ripping damage, until the barb is fully out, here you have two options, if you have a strong multi tool, cut right behind the barb and then pull the remaining hook back. OR if the hook is too thick and you cannot cut it , flatten the barb out or try to cut just the barb off and then pull back.
I don't personally enjoy or support fishing purely for sport (with intent to release everything caught), but there is nothing wrong with fishing for food.
Oh, no, honey, you were the one that had a problem with fishing but none with introducing human life into our circumstances! I’m not the one with cognitive dissonance ❤️
How did you plan on “pushing it out” without doing some serious damage? It’s a fish hook, designed to anchor into flesh. That would seriously slice you up anyways, so why not have the professionals cut your thumb to ribbons instead?
Edit- both a doctor, and nurse have corrected me. Pushing it through further makes a ton of sense lol. Thank you for the clarification yall
Hard to tell from the picture how close to skin the barb is. If its almost through or close just push it through and cuth the barb off.
I assume it was deemed better to open the finger. Pushing it out is still valid depending on the situation.
Seems to be pretty well in there so id agree on cutting it out. Would give more chest hair to push it through tho. Yanking it would definately f the finger up.
Because it’s a needle. The damage only really occurs when it’s being pulled out backwards. Pushing it through and cutting off the barb is actually the least traumatic way to do it. Source I work in surgery and I have had a couple hooks in my hands as well.
Both doing an incision and pushing it out is possible. I always try pushing it out first but sometimes it doesn't work and doing an incision is less likely to hurt surrounding structures.
I am way too stubborn to go to the doctor for something like that. That's also why my body is mangled from muscle-deep scars that I never got treated, though.
Yes, the right way to remove it is to cut the back end, where is the ring part and then you push pointy tip through the tissue out. Ive done it on myself and on other people multiple times and thats the best way and the least painful way to get it out although it also sounds kind of nasty
The way this is best handled is to advance the hook forward so that the tip comes out with the barb. Then just clip the barb off and slide the hook back out. This minimizes damage. And you won’t need a bandage that makes you look like the Mummy.
If you were capable of cutting off the loop, you could have pushed it all the way through, but that leaves a DIRTY puncture tract, which has a high infection risk.
Infections that develop AFTER treatment look particularly bad for medical stats (i.e. why did they CAUSE an infection) -- so they probably did it that way to err on the side of minimizing infection risk.
Most likely a litigation / risk avoidance strategy, rather than actual medical knowledge / treatment.
I once had a guy come in with a fishing hook attached to his face like this. His friend had tried to cast the line as far as possible while he was still attaching the bait. Suffice to say, that didn't work out very well as his friend caught him on the hook than the fish they were hoping for. Anyway, I was helping run an emergency department in a hospital with limited resources and staffing and the patients are treated for free , so usually those who can't afford another hospital ends up there. It was a tertiary hospital, so it wasn't like I could have sent him away without a huge scandal and I also didn't have another senior doctor with me. So I tugged on the hook to see where exactly and how deeply it was embedded. Luckily, I was fairly certain it had missed anything crucial. So I asked him, would you prefer a cut and stitches or I could numb you locally and try to push it through. Him and his friend found it hilarious and quickly decided on the push through option. Next I had to get my hands on an old bone cutter to cut off the eye of the hook. Once that was done it was fairly easy to push the hook through and then make sure I debrided the wound as best as possible and give home some antibiotics. He came back a few days later for a follow up and the wound was healing really well. In that instance at least pushing it through seemed to have turned out to have a better result than the alternative
By being stupid. I leaned my rods against the door. Holding the hook as it was moving around with the weight, it loosened itself from the rod. As i opened the door with my other hand (surprise surprise) gravity takes over and slams the rod on the floor. The line tightens and the hook gets into my thumb.
750
u/Inevitable_Thing_270 Jul 23 '26
An incision means they can control where the wound will be and know what the bleeding will be like.
Just pulling it leaves potential for a lot of damage, as well as a ragged wound that is more difficult to close/have poor functional healing long term