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Question
34 year-old left-hand dominant male sustained injury to left hand after his pressurized greasing-gun discharged into the palm of his hand. He has a small lac to the hand but is in extreme pain. On exam his hand is very puffy and he is neurovascularly intact (XR below) What is the next step in management?
Answer
Metacarpal fracture; emergent surgical consult is required
High-Pressure Injection Injuries (HPI) injuries
HPI devices (e.g., grease, paint guns, etc.) may cause injury when the device accidently discharges, typically into the operator’s dominant hand during attempts to clean the nozzle.
Injuries may initially appear benign, however injuries should be considered surgical emergencies because they often require debridement / washout of materials injected into deeper tissues.
Tissue damage is multi-factorial and includes direct injury (e.g., high-pressure tissue damage, vascular compression, etc.) and indirect injury from material injected into tissues (e.g., chemical inflammation / injury, granuloma formation, deep-tissue infections, etc.).
Radiographs may assist surgical planning by identifying subcutaneous air, debris, or unanticipated fractures.
Treatment:
- High-potential for disability and amputation so prompt aggressive therapy and surgical consult is crucial.
- Broad-spectrum prophylactic antibiotics and update tetanus
- Splint the extremity and keep it elevated while awaiting disposition
References
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