High pressure injection injury of the hand - a case report

Abstract

Introduction. High-pressure injuries (HPIs) of the hands which occur in about one out of every 600 hand traumas are caused by tools that emit high-pressure jet streams. These incidents which frequently involve paint or diesel oil can lead to material diffusion into tendon sheaths, impacting neurovascular bundles. HPIs are often underestimated due to their small entry wounds, but they pose serious risks from pressure, chemicals and infections so it is critically important to recognize these cases and treat them properly. Case report. A 42-year-old industrial worker suffered a high-pressure injury to his right hand’s second finger from a ruptured oil pipe (3 bar). Following surgical repair of the 1 cm laceration, the patient re-presented the subsequent day with escalating pain and edema extending dorsally. X-ray and ultrasound confirmed subcutaneous emphysema extending from the index finger to the palm. A multidisciplinary approach ensued, encompassing surgical incisions, drain placement and lavage with a chlorhexidine and hydrogen peroxide solution to reduce excessive oil retention. The wound was dressed in octenidine dihydrochloride bandages and chlorhexidine irrigation was conducted every two days. After 17 days the patient was transitioned to outpatient care, with necrectomy performed a month later. Normal finger function was restored after four months though with residual swelling. Discussion. The presented case underscores the severity of HPIs to the hands, emphasizing the need for fast and comprehensive management. The successful restoration of finger function and residual swelling after four months emphasize the importance of an attentive approach in managing HPIs for optimal patient outcomes. Conclusions. Doctors should assess the patient’s anamnesis and initiate appropriate treatment as soon as possible in cases of high-pressure injuries (HPIs). The use of multiple incisions and decompression, followed by wound washouts proves to be an effective treatment.