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Anatomy
Anatomy
Illustration by Dr. Lisa Bryski
High pressure injection injuries are caused by an injection of any substance (oil, grease, air, solvents, etc) at a pressures as high as 3,000-10,000 PSI (up to 400km/h).
This injection leads to dissection along planes of least resistance (ex. neurovascular bundles) and subsequently leading to vascular occlusion and soft tissue necrosis.
classic presentation
classic presentation
Patients are often in industry labourers, using paint, automotive grease, solvents, and diesel oil.
Their non-dominant index finger is the most commonly affected. It's very important to document type of injection, sequence and duration since the injury.1
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Clinical Tip: The entry wound is often benign looking and can be missed. Patients have a higher rate of amputation if surgery is delayed >10 hours post injury (as high as 50% with oil injections). 2
diagnosis
diagnosis
2
While the diagnosis is clinical, limb x-rays can be obtained to assess for spread of radio-opaque substances or air.
management
management
Non-operative treatment includes tetanus prophylaxis, parenteral antibiotics, limb elevation, early mobilization, admission & monitoring for compartment syndrome
However, most cases require operative management with exploration, irrigation & debridement, foreign body removal, fasciotomy, and broad-spectrum antibiotics.
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references
references
Rozmaryn, L. M. (Ed.). (2016). Fingertip Injuries: Diagnosis, Management and Reconstruction. Boston, MA: Springer.
Peters, G., Learch, T., White, E., & Forrester, D. (2014). High-pressure paint gun injury: clinical presentation and imaging findings. Emergency Radiology, 21, 627-630.
Verhoeven, N., & Hierner, R. (2008). High-pressure injection injury of the hand: an often underestimated trauma: case report with study of the literature. Strategies in trauma and limb reconstruction, 3(1), 27–33.
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