Fish-hook removal techniques
- Joan Bothner, MD
Joan Bothner, MD
- Professor of Pediatrics and Emergency Medicine
- University of Colorado School of Medicine
- Section Editors
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Fish-hooks may lodge in any body part, but the fingers and feet are most commonly involved. Most embedded fish-hooks can be removed in the emergency department. The choice of removal technique depends on the depth of penetration, body part affected, and type of fish-hook. This topic will discuss fish-hook removal techniques.
Any clinician may remove fish-hooks that are superficially embedded in the skin. Fish-hooks embedded in the eye, eyelid, or in vital structures should be removed by the appropriate surgical specialist.
There are no absolute contraindications to fish-hook removal. Subspecialty consultation should be obtained for fish-hooks lodged in the eye, eyelid, or in vital structures (eg, carotid artery, radial artery, peritoneum, testicle, urethra) or when a hook is embedded very near to these structures [1-3].
Initial emergency management of penetrating injuries to the eye is found in the table (table 1). (See "Open globe injuries: Emergency evaluation and initial management".)
TYPES OF FISH-HOOKS
Most fish-hooks lodge in the dermis or subcutaneous layers of the skin. The most common type of hook has an eyelet at one end, a straight shank, and a curved belly that ends in a barbed point on the inner curve that points away from the hook's tip (figure 1). Because the barb is set into the tissue, the fish-hook cannot be pulled out by the shank without causing tissue damage unless the barb is somehow disengaged from the tissue.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Aiello LP, Iwamoto M, Guyer DR. Penetrating ocular fish-hook injuries. Surgical management and long-term visual outcome. Ophthalmology 1992; 99:862.
- Malitz DI. Fish-hook injuries. Ophthalmology 1993; 100:3.
- Su, E. Removal of a barbed fishhook. In: Illustrated Textbook of Pediatric Emergency and Critical Care Procedures, Diekema, RA, Fiser, DH, Selbst, SM (Eds), Mosby, St. Louis 1997. p.727.
- Diekema, DS. Fishhook removal. In: Textbook of Pediatric Emergency Procedures, 2nd ed, King, C, Henretig, FM (Eds), Lippincott, Williams and Wilkins, Baltimore 2008. p.1102.
- Prats M, O'Connell M, Wellock A, Kman NE. Fishhook removal: case reports and a review of the literature. J Emerg Med 2013; 44:e375.
- Friedenberg S. How to remove an imbedded fishhook in five seconds without really trying. N Engl J Med 1971; 284:733.
- David SS. Fish-hook removal. Lancet 1991; 338:1463.
- Doser C, Cooper WL, Ediger WM, et al. Fishhook injuries: a prospective evaluation. Am J Emerg Med 1991; 9:413.