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High-pressure injection injuries to the hand
The Journal of the American Academy of Orthopaedic Surgeons
|January 3, 2014
Summary
High-pressure injection injuries to the hand are serious and need immediate surgery. Long-term hand dysfunction is common, and the benefit of steroids remains unclear.
Area of Science:
- Orthopedic Surgery
- Trauma Care
- Hand Surgery
Background:
- High-pressure injection injuries (HPIIs) to the hand are frequently underestimated.
- Despite improved understanding and reduced amputation rates, significant long-term morbidity persists.
- The efficacy of systemic steroids in managing HPIIs is not well-established.
Purpose of the Study:
- To review the factors influencing functional outcomes after HPIIs.
- To discuss the current treatment paradigms and uncertainties, particularly regarding steroid use.
Main Methods:
- Literature review of HPIIs focusing on injury mechanisms, treatment, and outcomes.
- Analysis of factors affecting functional recovery.
- Evaluation of the role of systemic steroids in treatment protocols.
Main Results:
- Functional outcomes are multifactorial, influenced by initial force, injected substance, infection, and surgical intervention.
- Delayed or inadequate débridement correlates with poorer outcomes.
- Evidence supporting the routine use of systemic steroids is lacking.
Conclusions:
- Urgent and comprehensive surgical débridement is crucial for managing HPIIs.
- Further research is needed to clarify the impact of various factors on long-term hand function.
- The role and effectiveness of systemic steroids in HPII treatment require further investigation.
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