High-pressure injection injuries in the hand: current treatment concepts.

BACKGROUND: High-pressure injection injury to the hand and upper extremity is a rare but very serious clinical entity. The objective of this article was to review the current available literature and highlight important topics.

METHODS: A PubMed literature search was undertaken with the terms "high pressure injection injuries," "injection injuries," "finger injection injuries," and other related terms. Articles were reviewed with specific attention to clinical presentation, treatment, outcome, and prognostic variables.

RESULTS: Most of the available literature included case studies, case series, retrospective cohorts, and literature reviews. The most common presentation of a high-pressure injection injury is a puncture wound on the nondominant index finger of a working class man in his mid thirties. Important factors at presentation include the time of injury and type and pressure of material injected. Initial treatment should include tetanus prophylaxis, broad-spectrum antibiotics, and urgent consultation with a hand surgeon. Injections with air, gas, or small amounts of veterinary vaccines can usually be managed with observation and serial examinations if there is not concern for compartment syndrome. Injections with other liquid materials typically require emergent surgical débridement, with the best outcomes occurring when treated within 6 hours. A wide surgical irrigation and débridement of necrotic tissues should be performed under general or regional anesthesia. Organic and caustic materials are associated with a higher amputation rate, and decreasing the time from injury to surgery improves the prognosis.

CONCLUSIONS: High-pressure injection injuries to the hand can result in permanent impairment. Proper diagnosis and urgent treatment are essential for a good outcome.