Impalement Injuries in Children: Patterns, Management, and Outcomes From a 10-Year Single-Center Review

Impalement injuries in children, though rare, pose unique diagnostic and surgical challenges due to unpredictable trajectories and frequent involvement of multiple organ systems. Literature is limited to isolated reports and small series, with few comprehensive analyses from pediatric populations.

We conducted a retrospective review of pediatric impalement injuries managed at a tertiary children's hospital over 10 years (July 2015-June 2025). These patients were first encountered by the general surgery and critical care team in the trauma center initially and were subsequently referred to Pediatric Surgery and respective specialities. Patients 12 years or below with impaled objects in situ or requiring operative exploration were included; minor punctures not requiring surgery were excluded. Data regarding demographics, mechanisms, injury sites, operative management, complications, and outcomes were analyzed descriptively.

Twenty-one children (median age: 7 y; range 4 to 12; 13 males, 8 females) were managed. Mechanism was accidental in all, most commonly falls onto fixed objects (81%). Injury distribution was oral cavity (7, 33.3%), abdomen (5, 23.8%), thorax/thoracoabdominal (4, 19.0%), perineum (4, 19.0%), and neck (1, 4.8%). Eleven children required major operative intervention (6 laparotomies, 4 thoracotomies, 1 tracheostomy); the remainder underwent wound repair or examination under anesthesia. Gastrointestinal involvement occurred in 9 patients, with 5 requiring fecal diversion. Blood transfusions were needed in 52%, and massive transfusions in 3 cases. Complications were observed in 8 patients (38.1%), including intra-abdominal/pelvic abscess, salivary leak, atelectasis, wound infection, and urethral stricture. Three patients (14.3%) died, all with major thoracic or abdominal injuries. Among 18 survivors, follow-up (median 12 mo) demonstrated complete functional recovery, including continence after stoma reversal and preserved urinary/gynecologic function in pelvic injuries.

Pediatric impalement injuries, though infrequent, demand meticulous multidisciplinary management. Outcomes are favorable with adherence to trauma principles, delayed removal of impaled objects until surgical control, and judicious fecal diversion in anorectal or contaminated injuries. Mortality is concentrated in thoracic and complex abdominal impalements, underscoring the need for early resuscitation, controlled extraction, and prompt surgical expertise.