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High-pressure injection injury
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High-pressure injection injury

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Contributors: Aabra Ahmed MD, Danielle Wilbur MD
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Synopsis

High-pressure injection injury : Index finger, Palm, Foreign body exposure, Hand
Causes / typical injury mechanism: High-pressure injection injuries are caused by human or equipment error while using an injection gun or high-pressure system, with resulting injection of substances into the body.

The combination of pressure and chemical inflammation can lead to compartment syndrome and soft tissue necrosis with superimposed infection. Delay in treatment can lead to amputation. It is important to note the time of injury and the irritant injected.

Classic history and presentation: The patient is a worker using a pressure gun or hydraulic system with accidental firing into their hand. The index finger of the nondominant hand is most commonly affected. The exterior injury may appear as a small punctate wound, and the patient may initially not have severe pain.

Prevalence:
  • Age – Typically young, working age (mid-30s).
  • Sex / gender – Males are more commonly injured.
Risk factors:
  • Work environment where high-pressure tools are used
  • Fatigue
  • Improper equipment training
  • Equipment failure
Pathophysiology: The resulting damage is from a combination of pressure from the device and the chemicals injected. The pressure dissects through the hand in the plane of least resistance, affecting the neurovascular structures and causing vascular compromise and possible compartment syndrome.

Codes

ICD10CM:
S61.449A – Puncture wound with foreign body of unspecified hand, initial encounter

SNOMEDCT:
733245000 – Puncture wound of hand with foreign body

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Pitfall: Do NOT be fooled by minimal appearance. The damage within the hand may be more significant and can worsen with time.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:03/25/2021
Last Updated:03/27/2021
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High-pressure injection injury
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High-pressure injection injury : Index finger, Palm, Foreign body exposure, Hand

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