Cases Of High-pressure Injection Injuries Research Articles

Funktionelle Ergebnisse nach Hochdruckeinspritzverletzungen der Hand

Background High-pressure injection injuries are devastating injuries that often lead to an amputation of the primarily affected finger. The available literature mainly focuses on amputation rates, while there is a lack of knowledge regarding functional results. Patients and Methods Between 1998 and 2016, 47 cases of high-pressure injection injuries of the hand were registered in our department. Out of these, data of 26 patients, all men with an average age of 42 (18-62)years, were included in a retrospective follow-up examination after 4 (1-12) years. We recorded DASH scores, pain intensity on visual analogue scales (VAS, 1-10), fingertip-to-palm distance, active range of wrist motion, grip strength, and two-point-discrimination ability (2PD). The statistical analysis was descriptive and was performed by analysis of correlation. Results The average DASH score of these 26 patients was 45 (30-93), pain intensity was 2.5 (0-9) on the VAS, fingertip-to-palm distance was 1 (0-4) cm. Active range of wrist motion was 99 (77-122) % of the contralateral side. Average grip strength was reduced to 67 (0-164) % of the contralateral side. Average 2PD was 9 (2-25) mm. Nineteen out of 26 patients returned to work. An amputation was necessary in 7 out of 26 cases. These patients had more pain and less grip strength. High latency from injury to operative treatment impaired functional outcome, which was statistically significant for DASH (p < 0.05). A trend to poorer outcomes was noted in cases of a more distal lesion and injection of toxic substances, whereas high injection pressure had no negative influence. Conclusion High-pressure injection injuries have serious consequences regarding hand function and frequently cause chronic pain. This affects patients with finger preservation as well as patients requiring an amputation. A further evaluation of prognostic factors requires a metaanalysis of functional parameters. The DASH score seems to be an expedient assessment tool.

Two cases of high-pressure injection injury – The importance of early, accurate, assessment and referral

Background: The emergency department physicians rarely see high-pressure injection injuries (HPI) to the hand. These work-related injuries can have a devastating effect on hand function, particularly if not treated early. These injuries are usually caused by the introduction of chemicals into the wound. Chemicals under high-pressure cause local tissue damage, ischemia, and acute and chronic inflammation. The initial assessment may suggest a trivial injury to the inexperienced physician. HPI should be considered as a surgical emergency. Wound exploration, cleansing, and decompression usually preserve the optimal functions. The prognosis of these HPI depends upon the time of presentation, the type of the fluid injected, the pressure, volume, site of injection and appropriate management. Aim: We aim to highlight the importance of early recognition of HPI by the emergency physician. Case presentations: We present two cases of HPI. Both of them presented with a small puncture wound on their hands within 1–2 hours of the injury. The first patient was treated with analgesia and antibiotics and was discharged home. He returned again to the Emergency Department after 24 hours with increased pain, swelling, and discoloration of the fingers. He was referred for surgical exploration but required amputation of the index finger. The second patient was immediately referred to the hand surgeon for surgical exploration. He was able to make a good functional recovery within 3 months of the accident. Conclusion: These cases highlight the importance of early identification and referral by emergency physicians to ensure appropriate multidisciplinary treatment to prevent long-term disability.

High-pressure plastic injection injury of the hand: case report

Occupational high-pressure injection injuries are not common but can be devastating, especially to the hand. Most of the time, full recovery does not occur. We present a case of high-pressure injection injury to the hand in a patient who worked in a shoe-making factory. As far as we know, this massive involvement of a limb in a high-pressure plastic injection injury has never been reported in the literature. Better controls are required to prevent injection injuries and when they do occur, a high index of suspicion is required with immediate referral for surgical review.

Diagnosis and surgical treatment of high-pressure injection injuries(HPII)of the hand

Objective To analyze the diagnosis and surgical treatment of 6 cases of high-pressure injection injuries (HPII) of the hand. Methods Six cases of high-pressure injection injuries to the hand treated from May 1997 to October 2007 were reviewed. The characteristics and treatment outcome were analyzed. ALl of these patients were male. Injured sites included index finger in 2 cases, middle finger in 2 cases, thumb in 1 case, and palm in 1 case. Oil varnish was injected in all patients. The time of admission to the hospital after trauma was 1 hour to 2 days. All cases were given surgical debridement, 2 cases were treated with direct surgical suture, 3 with secondary debridement, 1 with a third debridement. The last 4 cases with skin defect were treated with the reverse island flap pedicled on dorsal metacarpal artery and posterior interosseous artery. All cases were given systemic rehabilitation after the operation. Results All cases were followed up for 7 months to 6 years. Necrosis of finger didnt occur in any patient, and all 4 flaps survived completely. The healing time was 17 -35 days. All the patients complained cold intolerance, hypersensitivity and paresthesia within 1 -3 years after the operation. Four patients returned to their previous employment at an average 1.7 years postoperatively. Joint stiffness of the affected finger and its neighboring fingers occurred in 2 patients at postoperative year 4. Conclusion This study confirms the fact that high- pressure injection injury to the hand is a significant problem. The injury has significant impact on future function and reintegration into the work force. Standardization of the treatment regimen should be designed based on the severity of HPII. Key words: Hand injuries; Debridement; Surgical flaps; HPII

High-pressure Injection Injuries to the Upper Extremity: A Review of the Literature

The purpose of this review was to identify the relative impact of injected material, location of injury, time to debridement, injection pressure, infection, and the use of adjuvant steroid medication upon the need for amputation after high-pressure injection injuries to the upper extremity. A Medline literature search extending from 1966 to December 2003 was performed, referencing the key words "high-pressure injection injury," "grease gun injury," "paint gun injury," "pressure gun injury," and "high-pressure injection." The results were limited to the English language and to reports involving human subjects. Each abstract was reviewed to confirm that the described injury had occurred in the upper extremity and that it had truly been a high-pressure injection. The reference pages from each of the papers were reviewed to identify additional reports of high-pressure injection injury. Manuscripts describing injuries resulting from hand held syringes or other low-pressure mechanisms were excluded. All of the manuscripts were analyzed to identify the clinical outcome, age, hand dominance, site of injection, substance injected, injection pressure, elapsed time to wide debridement, use of steroids, and incidence of infection. These variables were subjected to a Pearson chi test to determine their impact upon the need for amputation. Four hundred thirty-five cases of high-pressure injection injury to the upper extremity were identified. The amputation rate after these injuries was 30%. The location of the injury and the material injected contributed significantly to the need for amputation. For injections of paint, paint thinner, gasoline, oil, or jet fuel (organic solvents), the amputation risk was lower if wide surgical debridement occurred within 6 hours of injury. Steroids did not impact the amputation rate or incidence of infection. The presence of infection did not affect the incidence of amputation. The risk of amputation after high-pressure injection injury to the upper extremity is highest with organic solvent injection into the fingers. Injections into the thumb or palm result in a much lower frequency of tissue loss. Emergent surgical debridement reduces the amputation risk after injections of organic solvents. From the available data, no conclusions could be reached regarding functional outcomes, other than amputation, after high-pressure injection injury.

FREE TOE PULP TRANSFER FOR DIGITAL RECONSTRUCTION AFTER HIGH-PRESSURE INJECTION INJURY

We report two cases of high-pressure injection injuries to the fingertip in which free toe pulp flaps were used to resurface the palmar surface of the finger following extensive wound debridement. There was good return of sensibility and, because of the high durability of the donor skin, both patients regained good functional use of the injured digits and returned to heavy manual work. There was minimal associated morbidity of the donor sites. The free toe pulp flap represents an excellent alternative for resurfacing the digit with a large residual skin defect after high-pressure injection injury.

Hydraulic Orbital Injection Injuries

A high-pressure stream from mechanical equipment may inject gas or liquids deep into the orbit with few initial clinical signs. Aggressive surgical debridement as used in the extremities for the treatment of injection injuries is not possible in the orbit. Four patients with orbital injection injuries from farm or industrial equipment are presented. Previously reported cases of high-pressure injection injury are reviewed. Two patients suffered localized anterior orbital inflammation partially responsive to steroidal and nonsteroidal anti-inflammatory agents. Late debridement was required in one patient for a persistent lipogranuloma. Two patients suffered more dramatic and diffuse injections of hydrocarbon mixtures, requiring emergent early surgical debridement and decompression for compressive orbital signs. All patients attained an adequate functional outcome, with one patient's vision limited by a coexisting ocular injury. High-pressure orbital injection injuries manifest a spectrum of signs ranging from acute inflammation with tissue necrosis and compressive visual loss to late chronic inflammation with a pseudotumor-like course. The authors recommend the initial treatment of orbital injection injuries with systemic antibiotics followed by prompt neuroradiologic imaging. Systemic corticosteroids should be added for confirmed injection injuries with surgical debridement of discrete masses and orbital decompression when indicated. Continued therapy with anti-inflammatory medication may be required to suppress chronic inflammation with selective late surgical debridement of lipogranulomas.

High-pressure Injection Injuries of the Hand

The majority of high-pressure injection injuries can produce serious damage to the hand. Nevertheless, the injury may follow a relatively benign course if the injected substance possesses a less harmful nature. Treatment for these injuries requires immediate and aggressive surgery in most circumstances, but conservative treatment may be justified in certain instances. During a 4-year period, eight cases of high-pressure injection injury were encountered. The types of injected material were: four from paint, and one each from grease, water, benzene, and hydraulic oil. Time is an important factor regarding the results, while the types of injected material modify the clinical courses. It is advisable that the etiology of high-pressure injection injury should be established initially, and this factor be taken into consideration in choosing treatment options.

High-pressure water jet injury of the hand

A rare case of high-pressure injection injury to the thumb with water is reported. The problem was managed without surgical exploration despite subsequent involvement of the small finger.