Paediatric hand injuries caused by spiked railings

We report five cases of hand injuries caused by spiked palisade railings. O ne patient sustained an open fracture of the distal phalanx with a disrupti on of the nail bed, and two patients had digital nerve injuries. Two patien ts presented with the railing still impaled in the fingers, one of whom had an ischaemic digit at presentation. All patients were male, between 9 and 12 years of age, and presented in the course of 1 month. Railings of this t ype would appear to be a significant cause of hand injuries, which may be p revented by legislation or a change in railing design.