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Johnson C, Newton W, LaRochelle L, Allen J, Daly C. High-Pressure Injection Injuries of the Hand in Community and Industrial Settings: Incidence and Trends. Hand (N Y) 2023:15589447231218404. [PMID: 38159240 DOI: 10.1177/15589447231218404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND High-pressure injection injuries to the hand have been reported in both the community and industrial setting with varying levels of severity. However, there are little epidemiologic data regarding the prevalence of pressure-injection injuries. The purpose of this study is thus to describe trends in emergency department (ED) encounters associated with pressure injection injuries, thereby informing potential investments in research and education for these injuries. METHODS The National Electronic Injury Surveillance System (NEISS), a nationally representative database of all ED encounters, was queried for all high-pressure injection injuries from 2012 to 2021. Patient demographic and injury data were collected and analyzed to describe trends in incidence, patient demographics, and sequelae of hand injury associated with an ED encounter for a pressure injection-related injury. RESULTS There were an estimated 15 307 (95% confidence interval: 15 051-15 562) high-pressure injection hand injuries from 2012 to 2021. Injuries were more frequent on weekends with the highest incidence on Sundays (18.9%) and Saturdays (18.0%) and during late spring and summer months (58.6%), with peak incidence occurring in May (16.8%). High-pressure paint injuries demonstrated a significantly higher rate of infection (23.7% of injuries) than pressure washer injuries (3.7%); however, pressure washer injuries were much more common overall (90% vs 10%). CONCLUSION High-pressure injection injuries to the hand and upper extremity represent a particularly concerning injury mechanism. Prompt recognition and proper management are crucial for improving outcomes. People that utilize pressure washers for household projects should be aware of the risks associated with these machines and utilize proper safety techniques.
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Affiliation(s)
| | | | | | - John Allen
- Medical University of South Carolina, Charleston, USA
| | - Charles Daly
- Medical University of South Carolina, Charleston, USA
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2
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Bascone CM, Sheber B, Dave D, Firriolo JM, Pereira C. Optimal Irrigant in High Pressure Paint Injection Injuries of the Hand. Plast Reconstr Surg Glob Open 2022; 10:e4064. [PMID: 35083106 PMCID: PMC8785931 DOI: 10.1097/gox.0000000000004064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022]
Abstract
High pressure injection injury to the hand with paint leads to amputation rates near 48%. Historically, authors utilized saline irrigation alone, but have high reoperation rates. We conducted a cadaveric study to determine the ideal detergent for effective paint removal from the soft tissue.
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3
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Shubashri J, Angus MD. Catheter irrigation as an unutilized novelty in the treatment of water-based paint injection injuries - a case illustration. JPRAS Open 2021; 30:138-145. [PMID: 34692969 PMCID: PMC8515401 DOI: 10.1016/j.jpra.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/20/2021] [Indexed: 11/26/2022] Open
Abstract
High-pressure injection injuries with paint have long been heralded as a condition requiring timely and aggressive debridement with relatively poor functional outcomes and a significant proportion of patients progressing to require amputation of the involved digit or limb. Catheter irrigation is regularly used in the treatment of common hand infections and wounds. However, this has not been described for the treatment of paint injection injuries. We describe a case of a young painter who sustained an accidental water-based paint injection injury and was successfully treated with minimally invasive surgical debridement augmented by the use of catheter irrigation, despite a delayed presentation. The patient had regained full function of his hand by four months from the index presentation and returned to work. We illustrate how not all high-pressure injection injuries require an extensive incision and that catheter irrigation can be a significant tool to augment a minimally invasive approach.
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Affiliation(s)
- Jeyaratnam Shubashri
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
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4
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Abstract
Background: High-pressure injections injuries to the extremities can result in significant disability, including amputation of the affected limb. Proprietary mixtures associated with drill mud and hydraulic fracking leads to frequent encounters with varied materials. The physician needs to be aware of the effect of these materials when inadvertent exposure occurs. Injected toxic materials cause extensive soft tissue inflammation and destruction. This puts the foot at risk not only to the cleaning fluid used, generally water, but any contaminant on the boot at the time of injury. This case report is the first known case report involving injection with drill mud contaminant and describes 2 oil field injuries resulting in the gross deep contamination of the foot from a high-pressure washer injury. Case Report: Two patients, a 46-year-old man (patient 1) and a 29-year-old man (patient 2) sustained high-pressure injection injuries to the foot. These patients underwent treatment with immediate broad-spectrum antibiotics and emergent irrigation and debridement on arrival to the treating facility. Neither patient underwent amputation of the affected extremity as a result of their injuries and achieved a full recovery and return to work. Conclusion: High-pressure injection injuries are operative emergencies. Treatment should include tetanus prophylaxis, neurovascular monitoring, broad-spectrum antibiotic coverage, emergent operative debridement for toxic materials. Despite the toxic nature of the injection injuries, aggressive treatment can improve the chance of salvage in these industrial injuries.
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Affiliation(s)
- Christopher Gerzina
- Department of Orthopaedic Surgery & Rehabilitation, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Joash Suryavanshi
- Department of Medical Education. Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA
| | - Jerry Grimes
- Department of Orthopaedic Surgery & Rehabilitation, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Feldman G, Hitti S, Rozen N, Rubin G. Molten metal high pressure injection injury of the hand. Hand Surg Rehabil 2020; 39:328-331. [PMID: 32387689 DOI: 10.1016/j.hansur.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
The second case of high temperature molten metal, high-pressure injection injury of the hand is reported here. Like in the previous case, there was an innocent-looking entry point with deep thermal injury to the flexor tendons and the digital nerves that appeared a few days after the injury and lead to finger amputation. LEVEL OF EVIDENCE: 5.
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Affiliation(s)
- G Feldman
- Orthopedic Department, HaEmek Medical Center, Yitshak Rabin Boulevard 21, 1834111 Afula, Israel
| | - S Hitti
- Orthopedic Department, HaEmek Medical Center, Yitshak Rabin Boulevard 21, 1834111 Afula, Israel
| | - N Rozen
- Orthopedic Department, HaEmek Medical Center, Yitshak Rabin Boulevard 21, 1834111 Afula, Israel; Faculty of Medicine, Technion, 3200003 Haifa, Israel
| | - G Rubin
- Orthopedic Department, HaEmek Medical Center, Yitshak Rabin Boulevard 21, 1834111 Afula, Israel; Faculty of Medicine, Technion, 3200003 Haifa, Israel.
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6
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Eells AC, McRae M, Buntic RF, Boczar D, Oliver JD, Huayllani MT, Restrepo DJ, Sisti A, Forte AJ. High-pressure injection injury: a case report and systematic review. Case Reports Plast Surg Hand Surg 2019; 6:153-158. [PMID: 32002465 PMCID: PMC6968540 DOI: 10.1080/23320885.2019.1654388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 06/17/2019] [Indexed: 11/17/2022]
Abstract
High-pressure delivery devices for paint and other substances can lead to severe injuries of the hand without immediate surgical debridement. We present a case of a high-pressure paint gun injury treated surgically with full resolution of function. A systematic review of the literature details outcomes of similar injuries.
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Affiliation(s)
- Annica C. Eells
- Mayo Clinic Alix School of
Medicine, Scottsdale, AZ (Eells) and Rochester, MN (Oliver),
USA
| | - Matthew McRae
- Division of Plastic Surgery, McMaster
University, Hamilton, Canada
| | - Rudolf F. Buntic
- Plastic and Hand Surgery, The Buncke
Clinic, San Francisco, CA, USA
| | - Daniel Boczar
- Division of Plastic Surgery and Robert D. and
Patricia E. Kern Center for the Science of Health Care Delivery, Mayo
Clinic, Jacksonville, FL, USA
| | - Jeremie D. Oliver
- Mayo Clinic Alix School of
Medicine, Scottsdale, AZ (Eells) and Rochester, MN (Oliver),
USA
| | - Maria T. Huayllani
- Division of Plastic Surgery and Robert D. and
Patricia E. Kern Center for the Science of Health Care Delivery, Mayo
Clinic, Jacksonville, FL, USA
| | - David J. Restrepo
- Division of Plastic Surgery and Robert D. and
Patricia E. Kern Center for the Science of Health Care Delivery, Mayo
Clinic, Jacksonville, FL, USA
| | - Andrea Sisti
- Division of Plastic Surgery and Robert D. and
Patricia E. Kern Center for the Science of Health Care Delivery, Mayo
Clinic, Jacksonville, FL, USA
| | - Antonio Jorge Forte
- Division of Plastic Surgery and Robert D. and
Patricia E. Kern Center for the Science of Health Care Delivery, Mayo
Clinic, Jacksonville, FL, USA
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7
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Feldman G, Rozen N, Eliyahu AC, Epshtein A, Saleem-Zedan R, Rubin G. High-pressure injection injuries of the fingers: Long-term follow-up in patients after extensive debridement. Hand Surg Rehabil 2019; 38:312-316. [PMID: 31400497 DOI: 10.1016/j.hansur.2019.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/12/2019] [Accepted: 07/30/2019] [Indexed: 11/18/2022]
Abstract
High-pressure injection injuries to the fingers resulting from the introduction of a foreign substance, such as oil or paint, through a minor puncture wound are rare but can have serious clinical consequences. The objective of this article was to examine the long-term outcomes after surgical debridement of these injuries. We present a retrospective case series of 8 adults who had a high-pressure injection injury to their hand and underwent surgical debridement in our facility. Data were extracted from our outpatient registry. Assessment included a full physical examination, grip strength, range of motion, two-point discrimination and Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. We followed 8 male patients for an average of 12.7 years. Their average age was 37 at time of injury and all had injured their right dominant hand. Seventy-five percent of the injuries were to the index finger. Seven out of the 8 patients returned to their pre-injury occupation, 4 out of 8 patients had reduced range of motion of the affected digit. Injury sequelae adversely affected activities of daily living (ADL) with an average QuickDASH score of 26. Grip strength in the injured hand was reduced by an average of 35% in 6 out of 8 patients compared with the uninjured hand. Sensation was also reduced in the affected digit in 7 out of 8 patients. All patients suffered from some level of neuropathic pain and/or cold intolerance. High pressure injection injury to the fingers is a serious event found amongst industrial laborers. In most patients, this injury will lead to long-term disability along with a negative impact on ADL. However, most patients eventually return to their pre-injury occupation. Extensive, single or repeat debridement of high-pressure injection injuries remains a valid treatment option with good long-term results.
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Affiliation(s)
- G Feldman
- Orthopedic Department, Emek Medical Center, Yitshak-Rabin boulevard 21, Afula, 1834111, Israel.
| | - N Rozen
- Orthopedic Department, Emek Medical Center, Yitshak-Rabin boulevard 21, Afula, 1834111, Israel; Faculty of Medicine, Technion, Efron St 1, Bat Galim P.O.B. 9649, Haifa, 31096, Israel
| | - A C Eliyahu
- Orthopedic Department, Emek Medical Center, Yitshak-Rabin boulevard 21, Afula, 1834111, Israel
| | - A Epshtein
- Orthopedic Department, Emek Medical Center, Yitshak-Rabin boulevard 21, Afula, 1834111, Israel
| | - R Saleem-Zedan
- Orthopedic Department, Emek Medical Center, Yitshak-Rabin boulevard 21, Afula, 1834111, Israel
| | - G Rubin
- Orthopedic Department, Emek Medical Center, Yitshak-Rabin boulevard 21, Afula, 1834111, Israel; Faculty of Medicine, Technion, Efron St 1, Bat Galim P.O.B. 9649, Haifa, 31096, Israel
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8
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Collins M, McGauvran A, Elhassan B. High-pressure injection injury of the hand: peculiar MRI features and treatment implications. Skeletal Radiol 2019; 48:295-299. [PMID: 29909479 DOI: 10.1007/s00256-018-3005-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 02/02/2023]
Abstract
High-pressure injection injuries of the hand are rare, but potentially devastating injuries. The amount of tissue damage is dependent on the magnitude of the pressure generated by the device and the composition of the injected material. The standard of care is emergent surgical debridement of the injected material and devitalized tissue. Although, preoperative advanced imaging is not routinely pursued, MRI may be helpful in determining the anatomic distribution of the foreign material, and associated soft tissue or osseous injury. We present a case of a 28-year-old male with complications related to a high-pressure grease injection injury to his non-dominant hand. The MRI demonstrated peculiar imaging features of retained grease deposits and played an important role in surgical planning.
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Affiliation(s)
- Mark Collins
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Adam McGauvran
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Bassem Elhassan
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
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9
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Abstract
Injection injuries occur most commonly in the hand and digits; however, there are a limited number of reports in the literature describing injection injuries involving the orbit. High-pressure orbital injection injuries pose a number of unique challenges to the treating physician, and the approach to treating these injuries remains controversial. Often times, the extent of tissue damage is not fully appreciated at presentation, which may lead to missed diagnoses or inadequate initial treatment. In this study, the authors describe a rare incidence of high-pressure orbital injection injury. A 19-year-old male presented to the emergency department after injection of his left orbit with oil-based paint. Worsening clinical symptoms and increasing intraocular pressures within the first 24 hours necessitated take back to the operating room for orbital decompression and debridement. After an initial improvement in symptoms, the patient's clinical status deteriorated again, requiring further orbital decompression and additional periorbital debridement. Two weeks after initial presentation, soft tissue reconstruction of the surgical wounds was performed with full thickness skin grafts. The patient's globe and vision were both preserved. Orbital injection injuries, though rare, are potential globe threatening injuries. Physicians should have a low threshold for intervention and patient's must be observed closely over the first 72 hours after injury. Early diagnosis, prompt debridement, and a multidisciplinary approach are keys to improving patient outcomes.
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10
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Hoyt KS, Ramirez EG. Management of Hand Injuries: Part III. Adv Emerg Nurs J 2017; 39:86-96. [PMID: 28463864 DOI: 10.1097/TME.0000000000000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Assessment of Acute Hand Injuries was discussed in Part I (). Part I reviewed approaches to the assessment of the patient with a hand injury and established a process for basic identification of the hand structures and function. Approaches to history taking and specific evaluations for the hand were discussed, and examples of the assessments were provided. Diagnostic approaches to support physical findings were discussed, and methods of radiological assessment provided assistance to the audience in making appropriate diagnosis in relation to hand injuries. Management of bony hand injuries was discussed in Part II. In Part II, the authors also described the epidemiology, radiographs, and the management of hand lacerations, fingertip injuries, and fractures. In this article, Part III, the management of tendon, ligamentous, neurovascular, and other specific hand injuries, along with the management of selected chronic hand conditions, is discussed.
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11
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Abstract
High-pressure injection hand injuries are often overlooked, with severe complications owing to the acute inflammatory response. Prognosis for depends on the type of material injected, location of injection, involved pressure, and timing to surgical decompression and debridement. Acute management involves broad-spectrum antibiotics, tetanus prophylaxis, emergent decompression within 6 hours, and complete removal of the injected material. Most patients have residual sequelae of stiffness, pain, sensation loss, and difficulties in returning to work. The hand surgeon's role is prompt surgical intervention, early postoperative motion, and education of patient and staff regarding short- and long-term expectations.
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12
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Abstract
Power tool injuries to the hand and wrist are complex injuries which can have a profound impact on the function of the patient. This article gives an overview of the principles, and provides a systematic approach, to the management and rehabilitation of the injured limb and patient required to minimize future disability.
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Affiliation(s)
- I Roushdi
- ST8 in Trauma and Orthopaedics in the Department of Trauma and Orthopaedics, Brighton and Sussex University Hospital, Brighton BN2 5BE
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13
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Eroglu SE, Tezel S, Salcin E, Denizbasi A, Onur O, Ozpolat C, Demir H. An Unusual Complication following Unconventional Use of High Pressure Injector. HONG KONG J EMERG ME 2013. [DOI: 10.1177/102490791302000208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
High pressure injection injuries most commonly occur in industrial accidents. In accident due to high pressure gun injuries, the nature of injected materials, the degree of toxicity, and the amount injected will affect the clinical outcome. Early vigorous treatment is essential to reduce morbidity. We reported a case of hand injuries due to inadvertent use of a high pressure injector device for haemostasis. 46-year-old male technician tried to stop bleeding from his injured hand by directing air jet from a high pressure injector to the wound resulting in significant subcutaneous emphysema. Adequate training and knowledge on occupational safety should be reinforced to avoid similar accidents.
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Affiliation(s)
| | | | | | | | | | | | - H Demir
- Fatih Sultan Mehmet Research and Training Hospital, Department of Emergency Medicine, Istanbul, Turkey
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14
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Affiliation(s)
- Ioannis P Pappou
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908, USA
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15
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Chaput B, Nouaille de Gorce H, Courtade-Saïdi M, Apredoaei C, Rongières M, Chavoin JP, Grolleau JL, Garrido I. [The role of a systematic second look at 48-72 hours in high-pressure injection injuries to the hand: a retrospective study]. ACTA ACUST UNITED AC 2012; 31:250-5. [PMID: 22981916 DOI: 10.1016/j.main.2012.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 05/07/2012] [Accepted: 07/01/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Poorly standardized, the management of high pressure injections (HPI) is frequently too late and inadequate, some teams reporting up to 50% of amputations. HPI causes inoculation of toxic particles in depth, particularly difficult to remove surgically. The persistence of this foreign material maintains local inflammation and increases the risk of infection. The objective of this article is to validate the benefit of a systematic "second look" at 48-72 hours in HPI. METHODS We conducted a retrospective study from 2006 to 2010, of patients who had a HPI into the hand. All patients had initial debridement surgery and a "second look" was systematically performed at 48-72 hours. RESULTS During this period, six patients were treated for a HPI of paint (n=4) or oil (n=2). The time between the accident and surgery was 12.4 hours (2-24). Four patients had good functional outcome with no disabling sequelae. We performed two amputations. At six months, five patients returned to work. CONCLUSIONS Early management determines the prognosis of the HPI. Extended debridement within six hours showed a better functional outcome than later treatment. Performing a systematic "second look" allows further washing/debridement and gives the possibility to be more conservative during the initial procedure. This second debridement allows excision of the newly formed necrosis and to evacuate the remaining toxic residues. Finally, patients reported good functional outcome.
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Affiliation(s)
- B Chaput
- Service de chirurgie plastique et reconstructrice, CHU Toulouse-Rangueil, avenue du Professeur-Jean-Poulhès, 31059 Toulouse, France.
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Gao X, Wu QH, Chen WS, Chen QX, Xu K, Li FC, Yan SG. An unusual high-pressure injection injury involving the cervical spinal cord. J Bone Joint Surg Br 2011; 93:1140-2. [PMID: 21768644 DOI: 10.1302/0301-620x.93b8.26116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
High-pressure injection injuries occur infrequently but are usually work-related and involve the non-dominant hand. The neck is a very rare site for such an injury. We describe the management of a 36-year-old man with a high-pressure grease-gun injection injury to his neck causing a cervical spinal cord injury. He developed severe motor and sensory changes which were relieved by surgical removal of the grease through anterior and posterior approaches.
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Affiliation(s)
- X Gao
- Department of Orthopaedics, Second Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, Zhejiang 310009, China
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Frank M, Hecht J, Napp M, Lange J, Grossjohann R, Stengel D, Schmucker U, Ekkernkamp A, Hinz P. Mind your hand during the energy crunch: Functional Outcome of Circular Saw Hand Injuries. J Trauma Manag Outcomes 2010; 4:11. [PMID: 20819215 PMCID: PMC2939582 DOI: 10.1186/1752-2897-4-11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 09/06/2010] [Indexed: 11/24/2022]
Abstract
Background Although injuries due to circular saws are very common all over the world, there is surprisingly little information available about their functional outcomes. As the socioeconomic impact of these injuries is immense and determined by the casualties' disability and impairment, it is the objective of this study to present data on the functional outcome, disability, and impairment of hand injuries due to electric circular saws. Methods Patients treated from 1999 through 2007 for circular saw-related hand injuries were contacted and asked for clinical follow-up assessment. The clinical follow-up protocol consisted of a physical examination and an assessment of static muscle power (grip and pinch strength). For assessment of the subjective experience of the patients regarding their injury-related disability and impairment, the DASH follow-up questionnaire was used. The occupational impact of these injuries was measured by number of lost working days. Finally, safety-related behaviour of the patients was investigated. Results 114 Patients were followed-up on average 52 months after the injury. Average in-house treatment was 8.8 days. Average time lost from work was 14.8 weeks. A significant reduction of static muscle testing parameters compared with the uninjured hand was revealed for grip strength, tip pinch, key pinch, and palmar pinch. Average DASH score was 17.4 (DASH work 15.8, DASH sports/music 17.7). Most patients had more than ten years experience in using these power tools. Conclusion The everyday occurrence of circular saw-related hand injuries followed by relatively short periods of in-house treatment might distort the real dimension of the patients' remaining disability and impairment. While the trauma surgeon's view is generally confined to the patients' clinical course, the outcome parameters in this follow-up investigation, with loss of working time as the key factor, confirm that the whole socioeconomic burden is much greater than the direct cost of treatment.
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Affiliation(s)
- Matthias Frank
- Department of Trauma and Orthopedic Surgery, Emergency Department, Ernst-Moritz-Arndt-University, Sauerbruchstr,, 17475 Greifswald, Germany.
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19
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Schenck T, Holzbach T, Machens HG, Giunta RE. [High pressure injection injuries of the hand. Rare but often underestimated]. Unfallchirurg 2010; 114:263-7. [PMID: 20644906 DOI: 10.1007/s00113-010-1819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Injection injuries of the hand are often underestimated because the full extent of the injury often only emerges after a delay. Flap coverage is often needed to avoid amputation. CASE REPORT In the case presented an epoxy resin injection trauma to the left index finger occurred. A critical blood circulation resulted and after demarcation of the injury a radical débridement was carried out. A heterodigital island flap was used to reconstruct the dorsum of the finger and 3 years after the trauma the patient has no impairments in daily activities. DISCUSSION The extent of the injury and the carcinogenic properties of the injected material are crucial for adequate treatment of injection injuries. Patients should be referred to specialized hand centers at an early stage.
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Affiliation(s)
- T Schenck
- Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
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20
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Frank M, Lange J, Napp M, Hecht J, Ekkernkamp A, Hinz P. Accidental circular saw hand injuries: trauma mechanisms, injury patterns, and accident insurance. Forensic Sci Int 2010; 198:74-8. [PMID: 20116188 DOI: 10.1016/j.forsciint.2010.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Revised: 10/14/2009] [Accepted: 01/07/2010] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Hand injuries due to circular saws are a common reason for patients seeking medical care in emergency departments. With respect to cases of insurance fraud, these injuries are of medico-legal interest. It is the aim of this study to investigate the critical circumstances of the incidents, the accident mechanism, and the specific injury patterns of circular saw related hand injuries with regard to accident insurance coverage. PATIENTS AND METHODS Circular saw related hand injuries for the years 1999 through 2007 were followed-up and assessed in detail. Type, severity and pattern of the injury were assessed. An accident analysis investigated characteristic of the activities, of the saws, of the stock/cutting material, operational activities of the operators prior to/at the time of the incident, and detailed information on the insurance status. RESULTS The follow-up study encompassed 114 patients. A majority of these were covered by private or statutory accident insurances. Compensation payments were made in all cases. All lesions involved one hand, mainly the left non-dominant hand. Thumb and index were at highest risk for injury. One-finger injuries occurred mainly at the middle or distal phalanx. With increasing number of affected fingers, the level of the injury moved closer to the proximal phalanx. A majority of injuries occurred during do-it-yourself activities. Among blade contact injuries, the so-called kickback-mechanism was at highest risk. CONCLUSION Positive circumstantial indications of a self-inflicted injury, which are often cited in the literature are less conclusive for the medico-legal decision finding. The detailed anatomic description of any lesions and the alleged accident mechanism as initially described by the patients in the emergency setting is the basis for any later accident reconstruction.
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Frank M, Schmucker U, Napp M, Stengel D, Hinz P, Ekkernkamp A, Matthes G. Humane killers, human injury: functional outcome of vole captive bolt injuries. J Trauma 2009; 67:617-23. [PMID: 19741410 DOI: 10.1097/TA.0b013e3181823500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND High-pressure blast injuries to the hand due to vole captive bolt devices are serious injuries that are to a great extent unknown to emergency care operators and trauma surgeons. There is no study on the functional outcome of these patients. METHODS We assessed the functional outcome of patients with injuries inflicted by vole captive bolt devices. Therefore, a protocol consisting of a physical examination and an assessment of static muscle power (grip and pinch strength) was performed. To capture the subjective experience of patients regarding their injury related disability and impairment, the DASH follow-up questionnaire was used. Based on clinical/radiologic findings and outcome, a classification of this unique subgroup of blast injuries was developed. RESULTS The functional outcome of 34 patients suffering hand injuries due to captive bolt devices between 2004 and 2007 was assessed. A significant reduction of static muscle testing parameters compared with the uninjured hand was revealed. Fourteen patients lost a digit. Average time lost from work was 5.4 weeks. CONCLUSION Vole captive bolt device-related hand injuries are followed by deterioration of hand function. The present observations alarmed national authorities. The manufacturers were required to take engineering and teaching measures to rule out handling errors that were identified as leading cause of injury.
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