High-pressure injection injuries of the hand

One hundred twenty-seven case reports of high-pressure injection injuries have been analyzed, and five patients of our own are reported. The injury usually occurs to young, working males, most often to their nondominant index finger. Without proper surgical intervention, the injected part often progresses to necrosis, debilitating fibrosis, and stiffness. The pathology is that of inflammation and foreign body granulomatous formation. Damage results from impact, ischemia resulting from vascular compression, chemical inflammation, and secondary infection. Recommended treatment has traditionally been early surgical decompression, removal of injected material, and antibiotics. There is some evidence that anti-inflammatory medication is of value. In the patients treated early with steroids and proper antibiotics, infection has not been a problem. We feel that treatment of these injuries should include: 1) Immediate, high-dose, parenteral steroids followed by high-dose oral steroids in tapered doses. Our present regimen consists of initial doses of hydrocortisone sodium succinate 100 mg intravenously every 6 hours until it appears that swelling and erythema have maximized and begun to diminish, then changing to oral prednisone 25 mg twice daily. Prednisone is then slowly tapered in 5- to 10-mg increments per day until stopped. If swelling, pain, and erythema begin to worsen, high-dose steroids are resumed and tapered again. 2) Extensive and complete surgical decompression and drainage of the injured part. 3) Appropriate broad-spectrum antibiotic coverage.