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

Area of Science:

• Trauma Surgery
• Hand Surgery
• Emergency Medicine

Background:

• High-pressure injection injuries (HPIIs) present with deceptively small wounds but can cause extensive internal damage.
• Injected materials can spread along fascial planes, leading to compromised neurovascular structures and acute compartment syndrome.
• Cytotoxic materials may cause chemical burns, tissue necrosis, and secondary infections.

Observation:

• Three industrial laborers presented with HPIIs from diverse materials (lubricant oil, car wash product, anti-corrosive primer).
• Clinical presentation included severe pain, swelling, tenderness, a small puncture wound, and digital hypoesthesia, indicative of compartment syndrome.
• All patients required immediate surgical exploration and debridement.

Findings:

• Surgical intervention involved compartment decompression, irrigation, debridement of devitalized tissue, and carpal tunnel release.
• Combined with antibiotics and tetanus prophylaxis, this aggressive approach led to satisfactory outcomes.
• Patients experienced significant clinical improvement, early discharge, and no long-term neurovascular deficits.

Implications:

• Early surgical intervention is critical for managing HPIIs and preventing devastating consequences.
• Prompt diagnosis and comprehensive treatment, including debridement and decompression, are essential for hand salvage.
• Postoperative physiotherapy plays a vital role in restoring function after high-pressure injection injuries.