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: Emergent 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.
- 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.