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
    • Clean water and air lower risk
    • Paint produces large, early inflammatory response with high rate of amputation
    • Grease causes small inflammatory response with lower rate of amputation

Clinical Features

  • Most frequently in hand/fingers
  • Benign appearance of small injection site in immediate post-injection period is misleading
    • With time digit becomes edematous, pale, and severely tender to palpation

Differential Diagnosis

Hand and finger injuries

Evaluation

  • Clinical diagnosis
  • Consider X-ray (may show extent of injection of radiopaque substances)

Management

  • Splint and Elevate
  • Emergent ortho/hand surgeon consult
    • Early surgical decompression and debridement
    • Increased rate of amputation if >10 hours to OR
  • Tetanus
  • Antibiotics
  • Analgesia
    • Digital blocks are contraindicated as wound already under high pressure

Disposition

  • Admit

See Also

References

Authors:

Ross Donaldson