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High Pressure Water Injection Injuries to the Hand: Perhaps Not a Benign Injury
Mark Tait, MD; Glenn Gaston, MD; John W. Bracey, MD; John S. Gaul, MD; Bryan Loeffler, MD
OrthoCarolina Hand Center, Charlotte, NC
Introduction: High pressure water injections of the hand are uncommon injuries, with only a few case reports in the literature. It is unclear from these case reports whether these injuries should be treated with surgical debridement or nonoperatively with close observation. We hypothesized that the outcomes of high pressure water injections treated with initial observation versus immediate surgical treatment will be similar.
Materials & Methods: Using the International Classifications of Diseases (ICD-9) and Common Procedural Terminology (CPT) codes, we identified our initial cohort of patients. Charts were reviewed to identify patients who had high pressure water injection injuries. Data collected included demographics, location of injection, hand dominance, type of initial treatment (observation or surgical), need for additional treatment, and complications.
Results: Fourteen patients were identified with high pressure water injections to the hand. Average patient age was 43 years, and 86% (12/14) were male. The non-dominant hand was involved in 11 of 14 (79%) cases. The most commonly involved finger was the index (7/14) followed by the middle (4/14). Six patients (43%) were initially treated with outpatient observation while 4 patients (29%) were taken immediately for surgical treatment. Additionally, 4 patients (29%) were admitted for observation and intravenous antibiotics all of whom were taken to the operating room within 24 hours for worsening clinical examination. Three of the 6 (50%) patients initially treated with outpatient observation eventually required surgical treatment at an average of 12 days post injury. One patient developed septic flexor tenosynovitis requiring operative debridement. Also a fingertip amputation was performed for tip necrosis in one case, while another developed a severe infection requiring amputation at the metacarpophalangeal joint. Two of the 3 delayed surgical cases required repeat operation for a post-operative complication, while only 1 of the 8 patients treated with early surgery required a repeat operation.
Discussion and Conclusion: Surgical treatment within 24 hours of high pressure water injection injuries resulted in a good outcome with few complications and a low rate of reoperation. Half of the initial nonoperative cases (3/6) required eventual surgical treatment due to infection or tissue necrosis. Delayed surgical treatment was associated with a higher rate of reoperation (2/3) secondary to post-operative complication. This study indicates that early surgical treatment of high pressure water injection injuries should be strongly considered.
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