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Compressed air injuries of the hand
Compressed
Air Injuries of the Hand
B. KLARESKOV, P. GEBUHR and P. RIDRDAM From the Hospital of Orthopaedic Surgery, Sorer, Denmark. Two cases of injection of compressed air into the hand are reported. The air was injected under a pressure of 5-15 Atm. Both cases had a benign course. This is in contrast to high pressure injection (40-400 Atm) with foreign material. Both patients had minor skin lesions before the accident. High pressure injection injuries to the hand are well known. In industry, accidental injections of diesel-fuel, grease and paint with hazardous results have been described (Gelberman, 1975). Compressed air injuries have been described in the eyeball (Hosni, 1973) and among patients undergoing dental surgery (Bavinger, 1982). Extensive survey of the literature revealed only two reports of compressed air injury to the upper extremities (Sasse, 1968; Arens, 1949). We report two cases which ran benign courses.
Case A: A seventeen-year-old right-handed labourer was admitted after a compressed air injury to his left hand. He had been cleaning metal boxes using a compressed air jet with a pressure of 8 Atm. In order to remove a splinter from his left hand he used the airstream at close quarters. He immediately felt pain and developed swelling of the back of his hand. Upon admission four hours later the subcutaneous emphysema had spread to the axilla. He complained of moderate pain, numbness and decreased movement of all five fingers. A puncture wound was found in the fourth web of the left hand. X-ray examination of the hand and arm showed air distributed beneath the subcutaneous layer and between the muscles extending to the shoulder joint (Figure 1). A smaller degree of emphysema was seen on the initial aspect of the thorax beneath the shoulder. Subsequently the emphysema decreased and on the sixth day he was discharged without complications.
Case B: labourer was A nineteen-year-old right-handed admitted following a compressed air injury to his left arm. He had been cleaning lorries with compressed air. He received a minor wound on the left hand and tried to stop the bleeding with the airstream. Instantly the hand Received for publlcatmn January, 1986. Peter Gebuhr, Snorresgade 3, I, 2300 Copenhagen
436
S. Denmark.
and the forearm swelled. Upon admission one hour later no further extension of the emphysema was palpated. There was a normal range of motion. X-ray revealed no signs of air in the tissues. The patient was treated with elevation and penicillin. Three days later there were no signs of subcutaneous emphysema and the patient was discharged without complications. Discussion Compressed air at 5-15 Atm. is widely used for cleaning purposes. Remarkably few injuries of the hand have been reported. All the reported cases had minor skin lesions of the hand (Sasse, 1968; Arens, 1949), and the air was introduced with the hose in intimate contact with the skin. It seems that normal skin is a sufficient barrier against compressed air within these pressure limits. Mucous membrane is a poor protection and traumatic emphysema is well known in eyeballs (Hosni, 1973) and in connection with dental surgery (Bavinger, 1982). The hand injury is most common on the non-dominant side and the air injection is typically due to a more or less thoughtless act in order to remove dust from the skin. The traumatic emphysema begins as an acute localised painful swelling. In a few hours the air has dispersed throughout the loose connective tissue and the pain decreases. The air is resorbed in two to three days. After five days the patient is free of symptoms. No sequelae are seen (Sasse, 1968; Arens, 1949). This is in contrast to high pressure injection injuries where foreign material is injected under pressures of 40-400 Atm. through intact skin. The result of this is often devastating (Gelberman, 1975). We recommend admission and observation of the patient for a few days until the symptoms have Broad spectrum penicillin was used subsided. prophylactically. THE JOURNAL OF HAND SURGERY
COMPRESSED AIR INJURIES
Fig.
1 Case
t Air is seen on the dorsum of the hand
References ARENS, W. (1949). Eine Seltene Verletzung durch Pressluft. Unfallheilkunde, 52: (56). BAVINGER, J. V. (1982). Subcutaneous and retropharyngeal emphysema following dental restoration: An uncommon complication. Annals of Emergency Medicine, 1117: 371-374.
VOL. 11-B No. 3 OCTOBER 1986
GELBERMAN, R. H., POSCH, J. L. and JURIST, J. M. (1975). High-Pressure Injection Injuries of the Hand. The Journal of Bone and Joint Surgery, 57A: 7: 935-937. HOSNI, F. H. (1973). Compressed Air Injury of the Eyeball. Archives of Environmental Health, 27: 1: 11. SASSE, W. and GRUSS, P. (1968). Eine besonderes Akt der Selbstschaedigung durch Pressluft. Unfallheilkunde, 71: (7): 309.312.
431
Air Injuries of the Hand
B. KLARESKOV, P. GEBUHR and P. RIDRDAM From the Hospital of Orthopaedic Surgery, Sorer, Denmark. Two cases of injection of compressed air into the hand are reported. The air was injected under a pressure of 5-15 Atm. Both cases had a benign course. This is in contrast to high pressure injection (40-400 Atm) with foreign material. Both patients had minor skin lesions before the accident. High pressure injection injuries to the hand are well known. In industry, accidental injections of diesel-fuel, grease and paint with hazardous results have been described (Gelberman, 1975). Compressed air injuries have been described in the eyeball (Hosni, 1973) and among patients undergoing dental surgery (Bavinger, 1982). Extensive survey of the literature revealed only two reports of compressed air injury to the upper extremities (Sasse, 1968; Arens, 1949). We report two cases which ran benign courses.
Case A: A seventeen-year-old right-handed labourer was admitted after a compressed air injury to his left hand. He had been cleaning metal boxes using a compressed air jet with a pressure of 8 Atm. In order to remove a splinter from his left hand he used the airstream at close quarters. He immediately felt pain and developed swelling of the back of his hand. Upon admission four hours later the subcutaneous emphysema had spread to the axilla. He complained of moderate pain, numbness and decreased movement of all five fingers. A puncture wound was found in the fourth web of the left hand. X-ray examination of the hand and arm showed air distributed beneath the subcutaneous layer and between the muscles extending to the shoulder joint (Figure 1). A smaller degree of emphysema was seen on the initial aspect of the thorax beneath the shoulder. Subsequently the emphysema decreased and on the sixth day he was discharged without complications.
Case B: labourer was A nineteen-year-old right-handed admitted following a compressed air injury to his left arm. He had been cleaning lorries with compressed air. He received a minor wound on the left hand and tried to stop the bleeding with the airstream. Instantly the hand Received for publlcatmn January, 1986. Peter Gebuhr, Snorresgade 3, I, 2300 Copenhagen
436
S. Denmark.
and the forearm swelled. Upon admission one hour later no further extension of the emphysema was palpated. There was a normal range of motion. X-ray revealed no signs of air in the tissues. The patient was treated with elevation and penicillin. Three days later there were no signs of subcutaneous emphysema and the patient was discharged without complications. Discussion Compressed air at 5-15 Atm. is widely used for cleaning purposes. Remarkably few injuries of the hand have been reported. All the reported cases had minor skin lesions of the hand (Sasse, 1968; Arens, 1949), and the air was introduced with the hose in intimate contact with the skin. It seems that normal skin is a sufficient barrier against compressed air within these pressure limits. Mucous membrane is a poor protection and traumatic emphysema is well known in eyeballs (Hosni, 1973) and in connection with dental surgery (Bavinger, 1982). The hand injury is most common on the non-dominant side and the air injection is typically due to a more or less thoughtless act in order to remove dust from the skin. The traumatic emphysema begins as an acute localised painful swelling. In a few hours the air has dispersed throughout the loose connective tissue and the pain decreases. The air is resorbed in two to three days. After five days the patient is free of symptoms. No sequelae are seen (Sasse, 1968; Arens, 1949). This is in contrast to high pressure injection injuries where foreign material is injected under pressures of 40-400 Atm. through intact skin. The result of this is often devastating (Gelberman, 1975). We recommend admission and observation of the patient for a few days until the symptoms have Broad spectrum penicillin was used subsided. prophylactically. THE JOURNAL OF HAND SURGERY
COMPRESSED AIR INJURIES
Fig.
1 Case
t Air is seen on the dorsum of the hand
References ARENS, W. (1949). Eine Seltene Verletzung durch Pressluft. Unfallheilkunde, 52: (56). BAVINGER, J. V. (1982). Subcutaneous and retropharyngeal emphysema following dental restoration: An uncommon complication. Annals of Emergency Medicine, 1117: 371-374.
VOL. 11-B No. 3 OCTOBER 1986
GELBERMAN, R. H., POSCH, J. L. and JURIST, J. M. (1975). High-Pressure Injection Injuries of the Hand. The Journal of Bone and Joint Surgery, 57A: 7: 935-937. HOSNI, F. H. (1973). Compressed Air Injury of the Eyeball. Archives of Environmental Health, 27: 1: 11. SASSE, W. and GRUSS, P. (1968). Eine besonderes Akt der Selbstschaedigung durch Pressluft. Unfallheilkunde, 71: (7): 309.312.
431