High Pressure Injection Injuries

HPI: Middle age male who presents with left index finger pain and swelling after injury involving high pressure paint spray gun. He has had increasing pain and swelling to distal portion of the finger since the incident 72 hours prior.

Physical Exam: Edema, warmth, erythema and purple discoloration to middle and distal phalanx of left index finger. Tenderness to palpation. Unable to flex and extend at DIP secondary to pain. (See image).  Afebrile. No other significant findings.

Imaging: no fracture or dislocation. Increased attenuation in soft tissues below second distal phalanx (see image)

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Management: This  patient had no fracture or dislocation and a relatively benign appearing exam. However, given mechanism of injury and high risk of underlying injury with high pressure injection injuries, patient was admitted to Ortho Hand Service. He was given clindamycin and tetanus vaccination. He was taken to the operating room for incision and washout. Significant damage to underlying fascia and tissue found with presence of white latex-type paint.  Patient did well post-op with out complications.

Key Points:  

• Always have very high suspicion for underlying tissue damage with high pressure injection injuries! 
  
• Although physical exam and imaging can be benign, nearly all of these types of injury cause significant damage and require operation with hand surgeon for incision and washout. 
  
• Important questions to ask the patient are type of fluid/paint involved, as well as the PSI of the machine (if known).