High-Pressure Injection Injuries - Pre-test


1. The risk of amputation in high-pressure injection wounds to the hand is:

A. Less than 10%
B. Lower with injection of organic solvents
C. Lower with the adjunct use of steroids
D. Higher if infection occurs
E. Higher with injection in the finger


2. A 26 year-old male presents to the emergency room one hour following an industrial paint gun injury involving the tip of the long finger as shown in Figure 1. Examination demonstrates a 3mm entrance wound at the tip of the digit. Mild swelling of the digit, hand and distal forearm is identified. Sensation of the digit is intact with capillary refill < 3 seconds.

Figure 1.

What is the recommended treatment?


A. Admission to the hospital with elevation of the arm and intravenous antibiotics
B. Irrigation of the wound in the emergency room and discharge home
C. Exploration of the digit in the operating room with debridement and irrigation
D. Placement of the hand into a splint and instruct on local wound care
E. Initiate wet to dry dressing changes, oral antibiotics with re-evaluation within 24 hours.



Journal of Hand Surgery (British and European Volume, 2005) 30B: 6: 588–592

3. Which of the following in high-pressure injection injuries have the highest risk of amputation?

A. Hydraulic fluid
B. Grease
C. Water
D. Air
E. Organic solvents

4. The amputation rate following a high-pressure injection of organic solvents is:
A. <10%
B. 10% - 20% 
C. 20% - 30% 
D. 30% - 40% 
E. >40%

5. In a 32-year-old patient presenting 24 hours after sustaining a high-pressure injection injury (3000 psi) with a paint gun (Figures 1 and 2), the factor contributing most to morbidity is:

A. Latex paint
B. Pressure setting of 3000 psi
C. Age of the patient
D. Delay in presentation
E. Handedness