Introduction: Impalement injuries are one of the rare presentations in the emergency department and present complex surgical challenges in management. Prompt transfer to tertiary center, pre-operative planning, and multispecialty involvement is crucial in the management of such cases. Case Report: We report a case of 40-year-old male who sustained impalement injury to big toe while digging a well with an iron rod which fell into the well from the ground. After quick assessment of vital parameters and ruling out major organ injury, wound extent was examined. The rod was successfully removed under directvision. The patient recuperated without sequelae. Conclusion: One should not get distracted by the appearance of the impalement injuries. After initial resuscitation, full trauma evaluation should be carried out before attending to local injury. Minimal manipulation, extraction of impaled object in operation theatre under direct vision, wound debridement and administration of antibiotics to prevent wound infection are pearls of the management of impalement injury.
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