High-pressure injection injury is a relatively rare presentation in emergency department (ED). The severity of the injury is usually underestimated perhaps due to the benign initial appearance. However, combination of mechanical high-pressure injury with concurrent chemical related injury (due to material injected) could lead to devastating outcomes.
A 58-year-old man presented to ED with swelling in his right hand up to forearm, which he noticed when he woke up in the morning. At about 15 hours prior to ED presentation, he injured his hand at his workplace with the spray from a paint gun that was used to spray micaceous iron oxide base coating paint. Immediately after the injury, patient went to a general practitioner (GP) clinic because of hand pain and small opening wound on his right palm, at the base of middle finger. Subsequently, the wound was sutured and he was discharged home after that. In ED, hand x-ray showed radio-opaque substance over the proximal phalanx of patient’s middle finger. He was referred to orthopaedics team with impression of high-pressure injection injury with compartment syndrome. He underwent wound debridement and fasciotomy of right hand. However, his right middle finger was amputated on day 7 of admission due to tissue necrosis.
Discussion & Conclusion
At the point of presentation, either in GP clinic or ED, clinician should be able recognise the seriousness of high pressure injection injury. These injuries require urgent and thorough surgical debridement. As the possibility for subcutaneous damage continuously increases, a delay for an adequate treatment raises the chance of finger amputation. Moreover, the injected fluid’s nature, the pressure, the volume and the location of injection, also has influence on the significance and extensiveness of subcutaneous damage.
high-pressure injection injury, hand injury, compartment syndrome