High-pressure injection injury of the hand: peculiar MRI features and treatment implications

High-pressure injection injury of the hand: Clinical usefulness of ultrasound as an early diagnostic tool

High-pressure injection injuries of the hand are uncommon accidents with potentially catastrophic complications. We present a case of a 49-years-old male with a high-pressure injection of motor oil in his left hand. Ultrasound accurately demonstrated soft tissue infiltration and late complications, playing a fundamental role in the treatment choice.

MR features of high-pressure injection injuries caused by grease and paints

OBJECTIVE

This study investigates the magnetic resonance (MR) features of high-pressure injection injuries (HPII) caused by grease and paints to detect the presence of foreign material and associated complications.

METHODS

Sixteen rat models with HPII were established by injecting industrial grease and marine paints (n = 8 each) into their thighs. All the rats underwent a 3.0 T MR scanning, including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), Fat-suppressed T2-weighted imaging (FST2WI), Susceptibility-weighted imaging (SWI), and Diffusion-weighted imaging (DWI). Follow-up MR scanning was performed from 1st to 4th weeks.

RESULTS

Acute subcutaneous grease and paints appeared as different signal intensity characteristics (grease: T1WI ↑, T2WI =, FST2WI ↓, SWI ↓, DWI ↓; paints: T1WI ↑, T2WI ↑, FST2WI ↑↓, SWI ↓, DWI ↓). As time progressed, the signal intensity of HPII lesions caused by both grease and paints became inhomogeneous. Impurity components of the foreign material appeared as marked low signal intensity on SWI. The signal intensity on DWI significantly increased subsequently due to purulent fluids (confirmed surgically).

CONCLUSIONS

HPII caused by grease and paints have a characteristic appearance on MR imaging. SWI can detect impurity components of the foreign material, while DWI is highly sensitive to abscesses and helpful in monitoring infections.

High-pressure injection injury: a case report and systematic review

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.

Management of High-Pressure Injection Hand Injuries: A Multicentric, Retrospective, Observational Study

Hand injuries after high-pressure injection are a medical emergency. These events occur frequently in workers during industrial cleaning, painting, and lubrication, and may have devastating consequences, leading to eventual amputation and poor functional outcomes. The authors have investigated the evolution, management, and outcome. Medical records of occupational medicine units and hand surgery units were collected in order to spot the high-pressure gear accident cases. Records were analyzed by dividing the subjects into two groups: those treated within 6 h and after 6 h of the trauma. A follow-up was carried out at least 1 year after treatment; the post-treatment outcomes were assessed. Of the 71 (100%) subjects, 26 (37%) were treated ≤6 h and 45 (63%) >6 h. A total of 28% (n = 20) underwent amputation. In 61% of cases, accidents had occurred in the iron and steel sector. High viscosity materials with a delayed treatment beyond 6 h seemed to determine compartmental syndrome and following amputation. A significantly better outcome was reported among subjects treated ≤6 h compared to those treated >6 h, 20% (n = 7) versus 26% (n = 9), respectively. Early management of this type of injury is crucial. The results of this study may contribute to providing guidelines to occupational physicians in order to best manage this type of emergency.