High-pressure injection injury

Background

• Surgical emergency
  • Amputation rates are as high as 30%
• Occurs with grease, paint, and fuel guns; usually injected into non-dominant hand
• Most important factor is type of injected material
  • Paint produces large, early inflammatory response w/ high rate of amputation
  • Grease causes small inflammatory response w/ lower rate of amputation

Diagnosis

• Benign appearance of small injection site in immediate post-injection period is misleading
  • With time digit becomes edematous, pale, and severely tender to palpation
• X-ray
  • May show extent of injection of radiopaque substances

Treatment

• Emergent ortho consult
• Early surgical decompression and debridement
  • >10hours to OR with increased amp rates
• Immobilize and elevate affected hand
• Tetanus
• Abx
• Analgesia
  • Digital blocks are contraindicated

Source

Tintinalli's