Sledge Hammer Impalement: a case report of challenges of managing a patient with a heavy pendant.

Introduction: Impalement injuries are well defined. Transfixion injuries involve impalement and are defined in terms of fixation usually to a large object.

Case Report: We report a spectacular case of sledge hammer impalement in the neck where the patient was transfixed, albeit to a small object, requiring movement of the patient and the transfixing object as a single unit.

Discussion: The patient was fixed to the head of the sledge hammer because he was unable to move with the heavy pendant.

Conclusion: We argue that transfixion injuries should be defined in terms of weight of the object in relation to the patient's weight and the ability of the patient to move (with) the impaling object.