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High Pressure Injection Injuries to the Hand
Erik Scott Marques, MD; Christopher Kennon Livingston, MD
University of Texas Health Science Center San Antonio, TX

Introduction: High pressure injection injuries to the hand are rare, but serious injuries that can result in substantial functional disability. Although these injuries mandate prompt evaluation and operative treatment, the severity is often underestimated by patients and some physicians. The purpose of this study was to review the presentation, operative management, and outcomes of this relatively uncommon injury.
Methods: We conducted a retrospective chart review of high pressure injection injuries to the hand managed by the authors over a period of 10 years.
Results: We identified 16 patients that sustained high pressure injection injuries involving the hand over a 10 year time period (2002-2012). All of the patients were male with a mean age of 34 years (range 15-52). All of the patient were right hand dominant. All of the high pressure injection entry sites occurred on the palmar aspect of the hand and digits including: the thumb (1/16 cases), the fingers (13/16), and the hand (2/16). The non-dominant index or long finger was involved in 44% of the cases. The substances injected included: paint (62.5 %), paint thinner (19 %), grease (12.5 %), and water (6%). All injuries presented with pain and diffuse swelling outside the injection entry site. Only 6/16 patients presented on the same day of the injury. The remainder (9/16 patients) presented in a delayed fashion ranging from 24 hours to 4 days post-injury. 5 patients were transferred from an outside hospital. All patients, except one, were taken for operative decompression and debridement of foreign material. Complete debridement was not possible in many of the cases when the foreign material was adherent to critical structures (neurovascular bundles, flexor sheath, skin flaps). One patient with an industrial water injection injury to the thenar eminence of the right hand was treated conservatively. 2 patients required repeat debridements. All patients were administered broad spectrum intravenous antibiotics during their hospital admission. Mean length of stay in the hospital was 3.9 days (range 1-10 days). Follow-up ranged from 0-9 months. Delayed soft tissue healing and varying degrees of stiffness at the MP and IP joints were the most commonly encountered postoperative complications. One patient required finger amputation. Most patients regained functional range of motion.
Conclusion: High pressure injection injuries to the hand are serious injuries that can incur considerable morbidity. Prompt evaluation, surgical treatment, and careful post-operative follow-up are required in order to maximize function.


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