High Pressure Injection Injury of the Hand Michael H. Childress, MD Ann Arbor, Michigan

Attention is called to the importance of prompt and adequate treatment of high pressure injection injury of the hand. High pressure injection injury of the hand is an emergent condition which usually results from a mishap with a paint, grease, or tear gas gun, fuel injection system, or high pressure hose used in oil exploration. The pressures generated vary from 60 to 15,000 psi.1 -10 Three such injuries, recently seen in three male patients at the University of Michigan Medical Center, are the subject of this report.

Case Reports Case 1: D. F., a 26-year-old male, while cleaning a spray paint gun, accidentally injected paint thinner into the palm of his right hand. An iodo-

Requests for reprints should be addressed to Dr. Michael H. Childress, Radiology Department, University of Michigan Medical Center, Ann Arbor, Ml 48109.

form gauze was inserted into the wound, but two days later the entire hand and forearm were swollen (Figure 1). Extensive debridement was performed and histologic examination revealed necrosis and suppurative inflammation of tissue. Two months after the injury, the patient regained use of his hand but complained of intermittent numbness of the third and fourth fingers. Case 2: C. M., a 45-year-old male, was using a high pressure grease gun when he accidentally injected grease into the right second proximal digital crease. Grease was noted to pass dorsal to the second metacarpal (Figure 2). Debridement and irrigation were promptly carried out and the wound was left open. Two months after the injury the wound was still healing, although strength and range of motion of the second digit were normal. Case 3: D. L., a 26-year-old male, accidentally injected paint thinner into his left index finger with a gun operating at 1,800 psi. After visiting two

JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 69, NO. 9, 1977

other hospitals and ten hours after the injury, the patient was seen in our emergency department. Necrosis of the distal two-thirds of the finger was noted. A radiograph revealed soft tissue swelling and subcutaneous emphysema. Three days after the injury, amputation of the second digit onehalf inch above the base of the second metacarpal was required. Histologic examination revealed necrosis of soft tissue and bone.

Discussion The initial clinical appearance of the hand or finger may belie the extent of injury which is determined by the site of trauma, physical and chemical nature of the agent, pressure on nerves and vasculature, and complicating infection.3'1 0-12 Although only a small entrance wound may be noted, a large amount of foreign matter may actually enter the tissues. The liquid penetrates until deflected by a tendon or bone. It then spreads in superficial or deep planes demonstrating a tendency to follow tendon sheaths.2 For this reason a simple incision will not provide adequate drainage. This explains the initial lack of response in Case 1 and probably 663

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Two days after . here is injury. T There is extensive soft tissue swelling of the right hand extending into the forearm.

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Figure 2. Case 2. The radiopacity (arrows) represents the grease in the soft tissue. Note swelling of the index finger.

explains the favorable response in Case 2. Adequate debridement is essential. Literature Cited 1. Kaufman

HD: The clinicopathological correlation of high pressure injection injuries. Br J Surg 55:214-218, 1968 2. Kaufman HD: The anatomy of experimentally produced high pressure injection injuries of the hand. Br J Surg

55:340-344, 1968 3. Mann RJ: Paint and grease gun injuries of the hand. JAMA 231:933, 1975

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4. Nahigian SH: Airless spray gun: A hand hazard. JAMA 195:688-691,

1966 5. Rees CE: Penetration of tissue by fuel oil under high pressure from diesel engine. JAMA 109:866-867, 1937 6. Smith FH: Penetration of tissue by grease under pressure of 7000 pounds. JAMA 11 2:907-908, 1939 7. Stark HH, Wilson JH, Boyes JH: Grease gun injuries of the hand. J Bone Jt Surg 43-A:485-491, 1961 8. Stark HH, Ashworth CR, BoyesJH: Paint-gun injuries of the hand. J Bone Joint Surg 49-A:637-647, 1967

9. Walton S: Injection gun injury of the hand with anticorrosive paint and paint solvent. A case report. Clin Orthop 74:141-145, 1971 10. Williams CS, Riordan DC: High velocity injection injuries of the hand. South Med J 67:295-302, 1974 11. Adams JP, Fee N, Kenmore PI: Tear-gas injuries. A clinical study of hand injuries and an experimental study of its effects on peripheral nerves and skeletal muscles in rabbits. J Bone Joint Surg 48-A: 436-442, 1966 12. Byrne JJ: Grease gun injuries. JAMA 125:405-407, 1944

JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 69, NO. 9, 1977

High pressure injection injury of the hand.

High Pressure Injection Injury of the Hand Michael H. Childress, MD Ann Arbor, Michigan Attention is called to the importance of prompt and adequate...
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