High-Pressure Injection Injuries to the Foot: A Case Report of 2 Patients

BACKGROUND: High-pressure injections injuries to the extremities can result in significant disability, including amputation of the affected limb. Proprietary mixtures associated with drill mud and hydraulic fracking leads to frequent encounters with varied materials. The physician needs to be aware of the effect of these materials when inadvertent exposure occurs. Injected toxic materials cause extensive soft tissue inflammation and destruction. This puts the foot at risk not only to the cleaning fluid used, generally water, but any contaminant on the boot at the time of injury. This case report is the first known case report involving injection with drill mud contaminant and describes 2 oil field injuries resulting in the gross deep contamination of the foot from a high-pressure washer injury. CASE REPORT: Two patients, a 46-year-old man (patient 1) and a 29-year-old man (patient 2) sustained high-pressure injection injuries to the foot. These patients underwent treatment with immediate broad-spectrum antibiotics and emergent irrigation and debridement on arrival to the treating facility. Neither patient underwent amputation of the affected extremity as a result of their injuries and achieved a full recovery and return to work. CONCLUSION: High-pressure injection injuries are operative emergencies. Treatment should include tetanus prophylaxis, neurovascular monitoring, broad-spectrum antibiotic coverage, emergent operative debridement for toxic materials. Despite the toxic nature of the injection injuries, aggressive treatment can improve the chance of salvage in these industrial injuries.