Case Report: High-Pressure Injection Hand Injury

Moderate Injuries. In moderate injection injuries, there is more significant tissue damage from any of the aforementioned materials, but with preserved neurovascular structures. Treatment often includes debridement in addition to antibiotic therapy.

Severe Injuries. These types of injection injuries often involve paints and solvents, high-pressure exposure, and usually present with an abnormal neurovasculature. The best chance for salvage injuries involves rapid surgical intervention for debridement and reconstruction.^9,10

Surgical Evaluation and Debridement

Despite optimal care, amputation and dysfunction rates with high-risk injection injuries (due to higher psi, organic solvents, and/or delayed definitive care) have been reported from 48% to 80%.^10-13 Immediate surgical evaluation is often recommended when injection injuries are encountered.^10,13 Patients who receive immediate surgical debridement (ie, within 6 hours from injury), specifically those injected with organic solvents, have a lower amputation rate than those who do not have immediate surgical intervention.¹³

In some reports, more than 80% of those injected with organic solvents who did not have immediate washout and debridement required amputation.⁴ Other effects of postponed debridement include delayed return to work time and decreased functionality of the hand.^13,14

Conclusion

Although high-pressure injection injuries often appear mild at initial presentation since the immediate symptoms of the neurovascular injury often resolves, patients often experience severe sequelae including infection, disability, or amputation. The severity of the injury not only depends upon the psi, but also the type and amount of chemical injected. Because of the high morbidity, it is imperative that emergency physicians are aware of and identify these types of injuries and their sequelae.^10,11,13,14

Dr Wilson is a third year resident in the department of emergency medicine at the Alpert Medical School, Brown University, Providence, Rhode Island. Dr Hack is the director for the division of medical toxicology at Brown University and the director of the educational program in medical toxicology.  He is an associate professor at Warren Alpert Medical School; and an attending physician in the department of emergency medicine at Brown University, Rhode Island Hospital, Miriam Hospital, Providence.

Disclosure: The authors report no conflicts of interest.