Introduction Penetrating injuries of the neck and chest are widely known [1, 2] while penetrating injury of the shoulder is rare. The shoulder girdle is the gateway for all vital struc- tures to the upper limb. Any penetrating injury in this area is likely to damage important neurovascular and visceral structures lying in the vicinity. We present an unusual case of penetrating shoulder injury resulting from a metallic rod, and describe our approach for removal of the rod and radiological and anatomical analysis of the case. Case report A 32-year-old man presented in emergency department with a penetrating injury of the right shoulder approximately one hour after a roadside accident. According to the patient, he was travelling in an autorickshaw and it turned upside-down after an accident. A rod-like metallic object, part of frame- work of autorickshaw, entered from anterior to posterior side of his right shoulder. At the time of presentation, his vital signs included blood pressure 112/74 mmHg, pulse rate 96 min -1 and respiratory rate 22 min -1 . A bent iron rod, L- shaped in cross-section, was in situ and measured 80 cm in length and 4 mm in thickness, while each limb of the L mea- sured 30 mm. Two-thirds of the rod was lying anteriorly and one-third was lying posteriorly (Fig. 1). There was no acti- ve bleeding from the entry or exit wound, no pulsatile or expanding haematoma, and no bruit at the shoulder region. Radial pulse on the affected side was comparable to that of the contralateral side in volume and character. Bilateral breath sounds were equal and no subcutaneous emphysema was present. Neurological examination of the right upper limb revealed no sensorimotor deficit. Radiographs of the right shoulder showed the metallic foreign body traversing the shoulder girdle through the scapular neck (Fig. 2). Due to the large foreign metallic CASE REPORT J Orthopaed Traumatol (2003) 4:136–138 DOI 10.1007/s10195-003-0026-1 R. Singh S.C. Sharma A.K. Sharma R. Mittal K. Preet H. Pai An unusual penetrating shoulder injury: a case report Received: February 2003 Accepted: June 2003 R. Singh • S.C. Sharma • A.K. Sharma R. Mittal () • H. Pai Department of Orthopaedics Paraplegia and Rehabilitation Postgraduate Institute of Medical Sciences 32/11J Medical Enclave Rohtak, Haryana, 124001 India K. Preet Department of Anaesthesia Postgraduate Institute of Medical Sciences Rohtak, Haryana, 124001 India Abstract A 32-year-old male sustai- ned penetrating injury of the right shoulder with an angled iron rod in a road side accident. He presented with the rod in situ in his shoulder. Fortunately there was no neurova- scular deficit. The metal rod was carefully removed with success, after cutting the rod with hacksaw to avoid neurovascular damage during removal. Key words Penetrating injury • Shoulder