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Clinical Summary

Many commercial devices can deliver liquids and gases at pressures exceeding 5000 psi. Unfortunately, these may accidentally introduce these substances into the body, leading to possible ischemia because of direct chemical irritation, venous outflow obstruction, arterial compression secondary to the volume of material, spasm, or edema. The injected material spreads along fascial planes, so the extent of injury can be quite misleading and is often subtle on initial presentation. Swelling and pain increase over time, but on initial evaluation, the examiner may find no apparent skin break or only a small puncture wound.

Management and Disposition

Immediate operative debridement is the treatment of choice; early consultation with orthopedics is necessary. Radiographic examination to evaluate for fractures and to delineate the spread of the injected material should be considered. Tetanus, analgesia, and broad-spectrum antibiotics should be administered. The affected extremity should be elevated and splinted.

Pearls

  1. Do not be misled by the “benign” appearance of the initial injury. Delays in treatment can lead to compartment syndrome.

  2. Digital blocks are contraindicated because of the potential for increased tissue pressure and compromise of tissue perfusion.

FIGURE 11.60

High-Pressure Injection Injury. Injury incurred by a grease gun that accidentally discharged into a hand. Note the swelling and erythema. (Photo contributor: Richard Zienowicz, MD.)

FIGURE 11.61

High-Pressure Injection Injury. Industrial worker with injection injury from sandblaster in the leg (A). Note the spread along fascial planes demonstrated radiographically (B). (Photo contributors: Timothy S. Forsythe, DO (A); Kevin J. Knoop, MD, MS (B).)

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