High-Pressure Injection Injuries of the Hand: A Report of Three Cases Presenting With Acute Compartment Syndrome

High-pressure injection injuries of the hand occur after contact with the nozzle of a high-pressure injecting system such as a paint gun or air compressor, usually on the non-dominant hand of industrial laborers. The severity and real extent of damage in high-pressure injection injuries are often hidden behind a small punctiform wound at initial presentation and are generally underestimated. High-pressure injected material spreads into the tendon sheath, along neurovascular bundles and fascial planes, resulting in neurovascular compromise and acute compartment syndrome. Some products are extremely cytotoxic and can lead to chemical damage and tissue necrosis, with the potential for secondary infection. We present three cases admitted to our department requiring urgent evaluation and treatment. All cases had a distinct mechanism of injury and different materials injected; nevertheless, all had a similar clinical presentation. Symptoms included severe pain, swelling, tenderness, a punctiform wound, and hypoesthesia of the fingers, consistent with acute compartment syndrome, which constitutes a surgical emergency. The first case involves a 49-year-old man who presented to the emergency department after an accidental injection of graphite lubricant oil into the palm of his right hand. The second case is a 57-year-old man who sustained a high-pressure injury from an injection of an industrial car wash product in the thenar region of his right hand. The third case is a 37-year-old man who presented after an accidental high-pressure injection of an industrial anti-corrosive primer into the left palm at the metacarpophalangeal level of the index finger. The three patients underwent immediate surgical exploration for the decompression of the thenar and mid-palmar compartments, copious saline irrigation, and wide debridement of the foreign material and devitalized tissues plus carpal tunnel release. This approach in combination with antibiotics and tetanus prophylaxis has achieved satisfactory results with significant clinical improvement and early discharge without neurovascular compromise. Prompt diagnosis, early surgical intervention, and postoperative intensive physiotherapy are essential for hand salvage and function restoration in this type of injury.