Background
High-pressure injection injuries occur when a high pressure injection device such as a paint gun or a grease gun injects into the worker. This commonly occurs to the nondominant hand when the worker is trying to clean the nozzle of the gun. The injury may appear benign. Future disability may be hidden behind a small, punctuate sore on the finger.
A high-pressure injection injury should be considered a surgical emergency. Immediate decompression and thorough cleansing of the offending material from the tissue is required to preserve optimal function.
Pathophysiology
Acute injury is caused by introduction of a foreign material, under high pressure between 2,000 and 10,000 psi, into the poorly distensible digital or palmar tissues. The pathophysiology involves acute and chronic inflammation and foreign body granuloma formation. Damage results from the impact, ischemia due to vascular compression, chemical inflammation, and secondary infection. Highly viscous substances (eg, grease) require higher injection pressures than paint or solvents.
Fuel and paint injections lead to the most severe inflammatory response with a high incidence of subsequent amputation. Grease- and oil-based compounds may lead to oleogranulomas with chronic fistula formation, scarring, and eventual loss of digit function.
Epidemiology
Mortality/Morbidity
Overall incidence of amputation approaches 48%.[1] Morbidity is dependent to a large degree upon the material injected. Paint solvents appear to cause the greatest damage and result in amputation in 60-80% of the cases. Grease, the more common injectant, causes a less severe inflammatory response. Amputation is necessary in about 25% of these patients.[2]
Sex
These injuries are rare in women.
Age
High-pressure hand injuries usually occur in young men while working, most often to their nondominant index finger. The average age at time of injury in one large review was 35 years (range, 16-65 y). These injuries occurred to the nondominant hand 76% of the time.[2]
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