High-Pressure Injection Injury

What It Is

• A soft-tissue injury (usually around the hands) caused by high-pressure injection

devices

Why It’s an Emergency

• Despite the often benign appearance of the injury (Fig. 1), the soft-tissue damage
beneath the skin is often extensive (Fig. 2). Additionally, the material injected is
often toxic/damaging to tissues as well, and can continue to cause damage after
injection.

How “Emergent” Is It?

• Emergent—Time to operative debridement is one of the major determinants of

outcome after these injuries, and should be done as quickly as possible.

When to Be Suspicious

• Any patient with a punctate wound from a possible pressure injection. History
taking is critical in these patients, and a detailed report of exactly how the injury
occurred and what device caused it is imperative.

© Springer International Publishing Switzerland 2017 27

M.C. Makhni et al. (eds.), Orthopedic Emergencies,
DOI 10.1007/978-3-319-31524-9_9
28 J. Shillingford

Fig. 1 Clinical appearance of injection injury

Fig. 2 Radiographic appearance of injection injury

High-Pressure Injection Injury 29

How to Diagnose

• Diagnosis is exclusively off history, since physical exam is often initially benign.

How to Treat

• Treatment is emergent operative irrigation and debridement, removal of foreign

material, and initiation of broad-spectrum antibiotics.

References

Amsdell SL, Hammert WC. High-pressure injection injuries in the hand: current treatment
concepts. Plast Reconstr Surg. 2013;132(4):586e–91. doi:10.1097/PRS.0b013e31829f4bb4.
Bekler H, Gokce A, Beyzadeoglu T, Parmaksizoglu F. The surgical treatment and outcomes of
high-pressure injection injuries of the hand. J Hand Surg Eur Vol. 2007;32(4):394–9. Epub
2007 Mar 30.