High-pressure injection injuries are true medical emergencies that can result in long-term complications without early and appropriate medical treatment to improve outcomes. The overall prognosis depends on the extent and severity of the injury. These injuries occur when a high-pressure fluid stream, such as from a hydraulic machine or a paint gun, penetrates the skin and underlying tissue. These injuries can cause extensive damage to the affected area, leading to complications such as infection, compartment syndrome, tissue necrosis, and nerve damage. High-pressure injuries with water or certain medications do not cause the same injury severity. Oil-based injection injuries can cause severe dysfunction if treatment is delayed, so surgical exploration, debridement, and fasciotomy are a requirement. Therefore, the most appropriate management is consultation for emergent surgical intervention to remove contaminated and damaged tissue and to remove any debris or contaminants.
The remainder of treatment typically involves stabilization, antibiotics, further surgical intervention, andrehabilitation. Initial stabilization of the injured limb involves immobilization or splinting to minimize movement andprevent further damage. Assessing the extent of the injury, including the depth of penetration, and X-ray imaging to evaluate for foreign body or bony involvement may be performed. Intravenous antibiotics (first- or third-generation cephalosporins) are administered to prevent infection, as high-pressure injuries are prone to bacterial infection. Further surgical intervention to repair damaged structures like tendons, ligaments, nerves, and blood vessels may be required to improve function or aesthetics. After the initial wound healing, rehabilitation may be required to restore function and improve mobility and may include physical therapy, occupational therapy, and other supportive measures.
Cold compresses and elevation of the extremity (A) may be used in an attempt to decrease pain and aid in swelling. However, it should not replace consultation with a hand surgeon and surgical treatment. Injection injury wounds are often underestimated due to their small size. Therefore, extensive irrigation with normal saline (C) will not be effective at removing debris or cleaning the area. Surgical irrigation is required. Intravenous antibiotics, not oral antibiotics (D), are administered to prevent infection while awaiting hand surgery evaluation.