High-pressure injection injury: benign appearance belies potentially devastating consequences

A 73-year-old farmer presented with a finger injury after the spontaneous rupture of a hydraulic hose. He was discharged home with surgical follow-up arranged for 3 days later. Despite their benign initial appearance (usually a small puncture wound) (Figure, A), high-pressure injection injuries require urgent surgical debridement.1,2 The severity of the injury becomes evident over time as inflammation, vasospasm and thrombosis develop (Figure, B).2 Delays in management are associated with poor outcomes, including increased risk of amputation (Figure, C) and long term functional loss.1,2 As more industrial and agricultural devices operate under high pressure, it is paramount these injuries are immediately recognised and appropriately managed.