High-Pressure Hand Injury Follow-up

  • Author: Glen Vaughn, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jan 31, 2011
 

Further Inpatient Care

Extravasation of the injected material may further jeopardize the limb.

Prompt decompression and directed debridement of the nonviable tissue is an important strategy to prevent further tissue damage.

Less-aggressive therapy may have a role in injection injuries with less irritating substances (eg, Freon).[7, 8]

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Further Outpatient Care

Outpatient management of high-pressure hand injuries is contraindicated.

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Transfer

Transfer patient to a facility with a hand specialist if none is available at the receiving hospital.

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Complications

Amputation is more likely if debridement is delayed more than 10 hours, especially with low viscosity substances.

Tissues that survive the initial injection injury but still contain grease, paint, or oil heal slowly and may develop multiple oleogranulomas of varying sizes.

In time, the oleomas drain through sinuses or open directly through the skin.

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Prognosis

Factors that determine the severity of the injury include the following:

  • Type and viscosity of the material injected
  • Time interval between injury and treatment
  • Amount of material injected and velocity of the injectant
  • Pressure of the appliance
  • Anatomy and distensibility of the site of injection
  • Presence of secondary infection

Injection of irritating substances under high pressure has the potential for disability and amputation despite prompt aggressive therapy.

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Contributor Information and Disclosures
Author

Glen Vaughn, MD  Director, Department of Emergency Medicine, Defiance Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

Dan Danzl, MD  Chair, Department of Emergency Medicine, Professor, University of Louisville Hospital

Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

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