Episode 984: Fish Hooks

Contributor: Megan Hurley, MD Educational Pearls: Assess first: confirm the hook isn't near vital structures. Automatic subspecialty consult for eye involvement or proximity to carotid artery, radial artery, peritoneum, testicle, or urethra Barbed hook: cannot be pulled back through the entry without disengaging the barb Removal Techniques String-Pull: best for superficial, single-barbed hooks Depress shank and eye of hook to disengage barb and then pull string taut and jerk suddenly along the long axis Can only be used when the hook is in a body part that can be firmly secured so it won't move during the procedure Little or no anesthesia needed

Push-Through & Snip: best choice when barb is near the skin surface Anesthetize first and advance the hook forward until the barb emerges. Cut off the barb and then back hook out Small exit wound, no sutures needed

Needle Cover: for larger hooks that are superficial Anesthetize first and then slide an 18 or 20-gauge needle along the hook until the bevel covers the barb. Then back out the needle and hook together

Cut-it-out: last resort Make an incision along the body of hook to barb and then remove hook

Adjuncts: Hydrodissection with lidocaine along the tract can ease removal Post-Procedure Irrigate thoroughly and apply antibiotic ointment Routine prophylaxis not needed because complications are rare Consider prophylactic antibiotics if hook is deeply embedded in high-risk area or contaminated by fresh water or salt water

References Aiello LP, Iwamoto M, Guyer DR. Penetrating ocular fish-hook injuries. Surgical management and long-term visual outcome. Ophthalmology. 1992 Jun;99(6):862-6. doi: 10.1016/s0161-6420(92)31881-0. PMID: 1630774. Malitz DI. Fish-hook injuries. Ophthalmology. 1993 Jan;100(1):3-4. doi: 10.1016/s0161-6420(93)31700-8. PMID: 8433823. Summarized by Meg Joyce, MS2 | Edited by Meg Joyce & Jorge Chalit, OMS4