- Frank Burke,
- Owen Brady
- Consultant hand surgeon Orthopaedic senior registrar Pulvertaft Hand Centre, Derbyshire Royal Infirmary, Derby DE1 2QY
Need swift diagnosis and decompression
Injuries to the hands caused by industrial high pressure injections have been reported since the 1930s. Rees first described the condition in 1937, the injury seen arising from a diesel engine injector system.1 Only in the late 1950s, however, did the widespread use of high pressure paint sprays and hydraulic systems increase the incidence of these types of injury. Veterinary high pressure injection injuries have received less attention, although many pose similar problems to those caused by industrial high pressure equipment.
When a high pressure injection injury occurs the kinetic energy absorbed by the tissues is substantial and the toxic material is often driven from fingertip to palm: 45% of patients seen over a five year period at our centre required a decompression that extended proximal to the carpal tunnel at the wrist. Injuries in which an irritant material (such as oil based paint) is injected have a particularly poor prognosis even with prompt exploration and debridement. Amputation of the finger is often required in these cases.2
The most …