High-Pressure Injection Injuries of the Hand

Abstract

Introduction The incidence of high-pressure injection injuries of the hand is low. Although the occurrence is rare, the precarious progression of the injury exacts prompt surgical evaluation in order to avoid complications and amputation. The current study was devised in order to make comparisons to the current data, in addition to supplementing the literature with observations regarding clinical course and management. Methods A multisurgeon, retrospective chart review from a single institution was performed. Inclusion criteria included cases involving a high-pressure injection injury to the hand that underwent surgical management. Patient demographics, injury details, and hospital course were all reviewed and recorded. Results This retrospective review identified 20 cases meeting criteria, all of which involved males. The average age at time of injury was 39.7 years (range, 21–71 years). The incidence of injection injuries over a 10-year time period was 2.1 cases per year. The nondominant hand was injured in 11 cases (63%). The most common site of injury was the index finger with 11 recorded incidents (55%). Other reported locations included the metacarpal (40%) and small finger (5%). Occupational data included 10 construction workers, 5 painters, and 2 cleaning crew members, and 3 had nonmanual occupations. Paint was the most commonly injected substance with 17 reported cases (85%). On average, the delay until surgery was observed to be 21.9 hours (n = 16). Only 1 patient underwent surgery at 6 hours after surgery. The average number of procedures performed was 1.8 (range, 1–4). Hospitalization duration was on average 3.9 days (range, 1–9 days), and the average follow-up length was 69 days (range, 7–112 days). There were no identified cases that necessitated amputation. Conclusions This form of injury most commonly affects male, middle-aged laborers. Our study found very low amputation rates when compared with the current literature, despite observing longer delays to surgery according to current recommendations. Limited comparisons can be made from data regarding clinical course and management because of the small sample size of the current study and the limited published data. This indicates a need for further exploration and collection of data involving parameters such as clinical course and management.

The effect of time from injury to fasciotomy in patients with acute upper extremity compartment syndrome

“…While the pathophysiology of ACS is consistent regardless of the initial cause, if the etiology of ACS is a high-pressure injection, material that has been injected must be debrided in addition to fasciotomy. [ 14 ] This study included two patients with ACS due to high-pressure cement and dye injection. Debridement was performed synchronously with fasciotomy in each patient.…”

High-pressure injection injury to the hand - a case report

“…High-pressure injection injuries are uncommon injuries that typically occur in the nondominant hand of young-to-middle aged males, in particular laborers. 4 – 5 These injuries account for 1 out of 600 hand traumas, with 1–4 cases seen at the average trauma center per year. 1 In a retrospective review of 20 cases involving high-pressure injection injuries, the incidence over a 10-year time period was 2.1 cases per year, with the nondominant hand injured in most cases (63%) and the index finger being the most common site of injury (55% of reported incidents).…”

“… 1 In a retrospective review of 20 cases involving high-pressure injection injuries, the incidence over a 10-year time period was 2.1 cases per year, with the nondominant hand injured in most cases (63%) and the index finger being the most common site of injury (55% of reported incidents). 4 These injuries appear with small superficial wounds, minimal pain, and little loss of function which can lead to underestimating the degree of damage. 2 This can result in a costly delay of appropriate treatment and can ultimately lead to severe morbidity or loss of limb since the rate of amputation following these injuries is 30%.…”