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. 2008 Apr;3(1):27-33.
doi: 10.1007/s11751-008-0029-9. Epub 2008 Feb 2.

High-pressure injection injury of the hand: an often underestimated trauma: case report with study of the literature

N Verhoeven  1 , R Hierner
Affiliations

High-pressure injection injury of the hand: an often underestimated trauma: case report with study of the literature

N Verhoeven et al. Strategies Trauma Limb Reconstr. 2008 Apr.

Abstract

The real extent of damage in high-pressure injection injuries (grease gun injuries, paint gun injuries, pressure gun in juries) is hidden behind a small and frequently painless punctiform skin lesion on the finger or the hand. These kinds of injuries require prompt surgical intervention with surgical debridement of all ischemic tissue. Possibility of a general intoxication by the fluid must always be ruled out. Postoperative intensive physiotherapy is essential for the final hand function. The initial benign aspect is frequently causing a delay for an adequate treatment while in the mean time the possibility for subcutaneous damage continuously increases. Because of this delay the chance of permanent reduced functionality in the hand or finger amputation raises. Not only the latency time to adequate treatment but also the injected fluid's nature, the pressure, the volume and the location of injection, has influence on the seriousness and extensiveness of subcutaneous damage. All these factors influence the functional outcome of the patient.

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Figures

Fig. 1
Fig. 1
High pressure injection injury in a 33-year-old industrial painter. a Clinical aspect at admission: small punctiform palmar skin lesion at left MCP II level. b X-ray of the left hand with radio dense fluid on MCP II and on the hand palm oblique view. c X-ray of the left hand with radio dense fluid on MCP II and on the hand palm dorso-palmar view. d Clinical aspect intraoperatively: planning of Incision. e Clinical aspect intraoperatively: exploration and debridement of the paint and necrotic tissue on the palmar side. f Clinical aspect intraoperatively: debrided tissue. g Clinical aspect intraoperatively: planning of dorsal Incision. h Clinical aspect intraoperatively: exploration of the dorsal side. i Clinical aspect 3 years post-operatively: complete finger flexion. j Clinical aspect 3 years post-operatively: complete finger extension (plantar view). k Clinical aspect 3 years post-operatively: complete finger extension (lateral view)
Fig. 2
Fig. 2
Algorithm for the treatment of high-pressure inject injuries on the base of nature of the fluid
See this image and copyright information in PMC

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