High-Pressure Injection Injuries to the Hand

High-pressure injections into the hand, burden devastating and permanent functional impairments. Many materials including paint, paint thinner, gasoline, oil and grease are reported as the causative agents. These injuries need multiple procedures and reconstructions most of the time and 40% of the injuries may end with amputation of the injured part.
The aim of this study was to report the treatment outcomes and methods of treatments of patients with high-pressure injection injuries of the hand.
We retrospectively reviewed the medical records, imaging files and demographic data of patients, who were treated at our center due to the high-pressure injuries to their hands. We recorded the kind of the injected materials, time to the first treatment procedure, times of operation, and methods of their treatments. The outcomes of the injuries as well as the deficiency of the digital joints motion were also reported.
Nine cases with high-pressure injury of the hand were enrolled in this study. All patients were male with mean age of 26.88 ± 7.52. Mean follow-up time was 28.55 ± 12.49 months. The dominant hand was the right side in seven patients and left in two patients. Injury was in the left hand of seven patients and right hand of two patients. Index finger was the most common involved part (five cases) followed by the thumb (two cases). Injected material was grease in seven cases, water-base paint and water, each in one case.Mean time delay to the first treatment procedure was 29.16 ± 25.66 hours for seven patients. This was exceptionally long for two patients (seven days and 24 months). Type of treatment was debridement and skin graft for three cases, debridement and cross finger flap for two cases, debridement for two cases and nerve graft for one case. Amputation of the necrotic digit was performed for one case. Mean hospitalization time was 8.33 ± 3.64 days for all patients.Mean total active range of motion (TAROM) deficit was 18.57 ± 13.13 degrees for seven cases. In one case, mean deficit of II to IV fingers was 170. Seven cases returned to their previous occupation. There was no correlation between time to first treatment procedure and TAROM deficit.
These benign-looking injuries should not be underestimated and classic management including immediate surgical decompression is recommended to minimize the functional impairments.