1de Courcey C, Jones MA. BMJ Case Rep 2021;14:e240953. doi:10.1136/bcr-2020-240953
Taser barb penetration causing phalangeal fracture
Cynthia de Courcey,1
Matthew A Jones2
Case report
To cite: de Courcey C,
Jones MA. BMJ Case
Rep 2021;14:e240953.
doi:10.1136/bcr-2020-
240953
1
Department of Plastic Surgery,
University Hospitals Coventry
and Warwickshire NHS Trust,
Coventry, UK
2
Trauma and Orthopaedics,
University Hospitals Coventry
and Warwickshire NHS Trust,
Coventry, UK
Correspondence to
Matthew A Jones;
​matthew.​jones2@​uhcw.​nhs.​uk
Accepted 17 April 2021
© BMJ Publishing Group
Limited 2021. No commercial
re-­use. See rights and
permissions. Published by BMJ.
SUMMARY
We present an unusual case of phalangeal fracture
resulting from direct penetration by the barb of a
conducted electrical weapon (Taser). When a Taser
is triggered, compressed gas propels two barbs
with trailing insulated wires which deliver a pulsed
electrical discharge on contact. A 51-­year-­old man
presented with a single barb of the Taser embedded
in the diaphysis of the proximal phalanx and an
associated open fracture. The barb was removed
under local anaesthesia. The fracture was stable and
was mobilised in a flexible splint. Oral antibiotics
were commenced in recognition of the risk of flexor
sheath and bone inoculation. While the most severe
complications associated with Taser are related to
the electrical component, the most common injuries
are associated with falls and barb penetrations.
Clinicians must be mindful of the risk of fracture,
infection and soft tissue injury when such a foreign
body penetrates a phalanx.
BACKGROUND
The global trend of increasing adoption of Tasers
by law enforcement organisations is also seen in
England and Wales where its use by police forces
increased by 39% in 2018/2019 compared with
the previous year.1
The upper limb accounts for
7.9% of Taser injuries.2
When the trigger is depressed, a Taser fires
two barbs with trailing insulated wires up to
7.6 m at 50 m/s. On contact with a suspect’s skin
or clothing, an electrical discharge of 50 000 V
(2 mA) is delivered in a pulsed fashion over 5 s,
resulting in muscular tetany and incapacitating
the subject.2
Larger or repeated doses can be
delivered by keeping the trigger depressed or by
depressing it repeatedly.
Osteomyelitis or suboptimal management of a
phalangeal fracture can lead to long-­term pain
and dysfunction in the hand. It is therefore critical
to recognise the potential for these complications
and take steps to mitigate them.
CASE PRESENTATION
A 51-­year-­old man was apprehended by Taser
and was brought to the Urgent Treatment Centre
(UTC) at the Rugby site (peripheral hospital) of
University Hospitals Coventry and Warwickshire
NHS Trust during the COVID-19 pandemic.
There was a wound over the dorsum of the digit
at the level of the proximal phalanx where the
barb had entered and was still present. Clinical
examination demonstrated intact neurovascular
and tendon function. The wound appeared clean
and there was no exit wound. Radiographs were
requested to identify the location of the barb
and to identify any fracture.
INVESTIGATIONS
Radiographs revealed that a single Taser barb
was embedded in the diaphysis of the proximal
phalanx of the right ring finger. There was an
associated, minimally displaced, long oblique
fracture originating at the penetration site and
exiting the phalanx distally via the radial cortex
(figure 1).
DIFFERENTIAL DIAGNOSIS
The diagnosis of foreign body penetration and open
fracture is clear from the history, examination and
radiographic examination of the patient.
TREATMENT
The barb was removed easily with a needle
holder in a treatment room in the UTC under
1% plain lidocaine digital block (figure 2).
This was facilitated by a stab incision which
also allowed for irrigation to the depth of the
wound. The fracture was clinically stable. The
extensor tendon was perforated but did not
require repair. Repeat radiographs showed that
the fracture had spontaneously reduced after
barb removal and did not require fixation. The
digit was dressed with Inadine and Cosmopore
and was mobilised in a Bedford splint. A course
of oral co-­amoxiclav was commenced in recognition
of the risk of flexor sheath and bone inoculation,
and the patient was discharged back to
police custody.
OUTCOME AND FOLLOW-UP
Fracture clinic with radiographs at 1 week and
telephone follow-­up at 4 weeks confirmed that
the patient made a full recovery.
DISCUSSION
Developed by physicist Jack Cover in the late
1960s and commercialised in 1974, the device
and acronym were inspired by the novel ‘Tom
Swift and his Electric Rifle’ (TASER), which
features a character who invents a rifle that
shoots bolts of electricity.3
The initial ‘A’ was
added to facilitate the acronym.
The Taser was initially available for sale to the
public in the USA in 1993, but supply to law
enforcement agencies did not begin until 1999.4
Since then, the global use of Tasers has grown to
over 13 000 agencies in 44 countries, including
law enforcement and correctional and military
agencies in the USA, Canada, UK, France,
Australia and New Zealand.4
2 de Courcey C, Jones MA. BMJ Case Rep 2021;14:e240953. doi:10.1136/bcr-2020-240953
Case report
Reports of arrhythmias and sudden death are among
the most severe adverse events of its use in the field. It is
recognised that a greater proportion of those who died
following Taser exposure had pre-­existing cardiovascular
disease (50%), use of stimulants (>75%), a state of ‘excited
delirium’ (>75%) and prolonged exposure (median discharge
durations of 17–25 s).3
A review of complications following
Taser exposure concluded that while the most severe events
(such as cardiac arrhythmia) relate to the Taser’s electrical
component, the most common causes of injury are barb
penetration and falls.3
Penetrating hand injury from a Taser barb is rare. TASER
International advise that the back should be the point of aim
where feasible.5
The recommended frontal point of aim has
been amended from the centre of mass to the lower centre
of mass to minimise the risk of facial injuries and potential
arrhythmias from cardiac involvement.5
This also increases
the effectiveness in close-­spread discharges of Tasers by
increasing the likelihood that at least one barb will engage
the major muscles of the pelvic girdle or thigh.5
To date, there has been only one other case of Taser-­related
hand injury treated at our institution, and in that case, there
was no bony involvement. In the literature, there are four
other reported cases of phalangeal penetration worldwide,2
but this is the first reported case of phalangeal fracture
from direct barb penetration. This may be because the other
patients were younger and had a higher bone density. Fractures
attributable to direct barb penetration are rare due to
soft tissue interposition and are more likely a result of falls
from pain or temporary paralysis on device activation.2
It
is interesting to note a case report of frontal bone penetration
in a 23-­year-­old requiring surgical removal of barb from
skull and cerebrum, emphasising the significant force associated
with the Taser barb and the relevance of anatomical site
in injury severity.6
The Taser can also be deployed in ‘drive stun’ mode,
where, instead of firing the barbs from a distance, the device
is directly applied to the subject. A patient was reported
to develop a complete brachial plexus palsy, with residual
deltoid weakness and forearm paraesthesia at 2 years of
follow-­up, when a Taser was applied to Erb’s point in this
way.7
In summary, penetrating injury to the hand as a result of
a Taser is rare. Injuries are more likely to result from falls
secondary to temporary paralysis. However, it is paramount
for clinicians to be aware of the potential for penetrating
injury to the hand on the background of wide and increasing
adoption of Tasers. This case illustrates the pertinent aspects
of managing an open penetrating hand injury from a Taser
barb with associated foreign body embedment and open
fracture.
Acknowledgements  We acknowledge the support from Helga Perry and the
University Hospitals Coventry and Warwickshire library services for proofreading and
article submission processes.
Contributors  Both authors have contributed substantially to the conception of
the manuscript, reviewed and approved the final version for publication, acted
as guarantors (accountable for all aspects of the manuscript), and were both
directly involved in the treatment and management of the patient in this case.
CdC undertook the literature research and initial drafting of the manuscript. MAJ
undertook critical revision of the manuscript.As a case report, MAJ identified the
case as worthy for publication.
Funding  The authors have not declared a specific grant for this research from any
funding agency in the public, commercial or not-­for-­profit sectors.
Competing interests  None declared.
Patient consent for publication  Obtained.
Provenance and peer review  Not commissioned; externally peer reviewed.
Figure 1  Radiographs demonstrating embedded barb and fracture of
the proximal phalanx, right ring finger.
Figure 2  Barb removed from the patient.Taser X2 barb dimensions:
11.5 mm (length), 0.76 mm (thickness) and 1.7 mm (widest point).
Patient’s perspective
The finger has recovered reasonably well.The scarring is raised
and, being the ring finger, I find it too uncomfortable to wear a
ring. I get the odd twinge in the finger. However, I can ride my
motorbike again and I have not lost any strength or dexterity in
my hand.
Learning points
►► A targetted history and examination is mandatory to
characterise bony and soft tissue trauma in cases of Taser-­
related injury, including barb penetration, falls, neurological
deficit and arrhythmias.
►► Recognise the risk of osteomyelitis and other deep infections
as a result of foreign body penetration and prescribe
prophylaxis accordingly.
►► Early mobilisation is critical in the rehabilitation of all hand
injuries and should be undertaken as soon as the injury
pattern will allow.
3de Courcey C, Jones MA. BMJ Case Rep 2021;14:e240953. doi:10.1136/bcr-2020-240953
Case report
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[Accessed 22 Mar 2021].
	5	 TASER International.Training Bulletin 15.0 Medical Research Update and Revised
Warnings.Version 2.0. [Internet], 2009.Available: https://​media.​cdn.​lexipol.​com/​pdfs/​
TASER_​Media_​Bulletin.​pdf [Accessed 23 Mar 2021].
	6	 Le Blanc-­Louvry I, Gricourt C,Touré E, et al.A brain penetration after Taser injury:
controversies regarding Taser gun safety. Forensic Sci Int 2012;221:e7–11.
	7	 Bonnan M, Zerbib J-­L, Barroso B, et al.Acute brachial plexus lesion complicating a
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