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High-pressure injection injury
From WikEM
Contents
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
- 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
- Radiograph positive
- Radiograph negative
- Dupeytren contracture
- Boutonniere deformity
- Hand and finger tendon injuries
- Ganglion cyst
- De Quervain tenosynovitis
- Intersection syndrome
- Drummer's wrist
- Extensor digitorum tenosynovitis
- Vaughn Jackson syndrome
- Snapping Extensor Carpi Ulnaris
- Compressive neuropathy, "bracelet syndrome"
- Scaphoid fracture
- Osteoarthritis
- Infiltrative tenosynovitis
- Gout
- Rheumatoid arthritis
- Trigger finger
- Mallet finger
- Jersey finger
- Jammed finger
- Subungual hematoma
- Fingertip laceration
- Metacarpophalangeal (MCP) ulnar ligament rupture (Gamekeeper's thumb)
- Nail avulsion
- High-pressure injection injury
Evaluation
- Usually clinical
- 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
- >10hours to OR with increased amp rates
- Tetanus
- Antibiotics
- Analgesia
- Digital blocks are contraindicated as wound already under high pressure
Disposition
- Admission
