A sharp metal object, such as a needle, heavy wire, or nail, is driven into the soft tissue. The patient may arrive with an additional large object attached (e.g., a child who has stepped on a nail going through a board) (Fig. 139.1). Any of these skin-piercing foreign objects, such as impaled Taser darts, can be quite dramatic and can be the cause for emotional distress in both the patient and others involved. These events are not uncommon; there are about 25,000 annual emergency department (ED) visits due to nail gun use alone, half of which involve the hand.