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The late complications of a 50 year old palmar injection trauma with color ink

Injection trauma occur preferably  at  the area of the index finger of non dominant  hand  (1,2). The degree of injury is related to the injection quantity, the substance and the injection pressure. In particular, oil-based liquids lead to tissue necrosis and  infections (amputation rate up to 50%, water-based 0%) (3).

Instant hand surgical inspection and debridement are a must in colored injetion trauma. The case illustrated describes the long term complications of  a conservative  treated  palm  injection trauma with color ink.

Case Report
A 67 year old female patient suffered in school age a palm  injection injury by an ink needle at the level of a1 pulley. The following infection with lymphangitis was treated conservatively.After a 49 years  with full manual function , the patient reports a sudden-onset lashing pain in the area of the primary injury and increasing flexion of the D4 long finger.The preoperative findings documented a PIP  joint contraction in 70 degrees flexion.The palm shows a retracted scar at the level of the pulley and a  Dupuytren’s disease.
The surgical operation was performed in hand block . After the sharp preparation of the skin flap a dark blue ink scar conglomerate was found.
A neurolysis of Nerv 7 and Nerv 8, the excision of the Dupuytren contracture and the release of the A1 pulley were performed.
The inspection of the flexor tendons showed a missing superficial tendon and the intact deep flexor tendon.
The arthrolysis the PIP joint was carried out closed.
Postoperative finding shows an almost complete extension of D4 long finger at hand level
Discussion
The long-term consequences of a palmar injection trauma are varied and difficult to predict. Injuries of the flexor tendons, nerve and vascular lesions and contractures of the finger joints can occur  isolated or  combined.The above case report also showes a traumatic induction of a M. Dupuytren and a A1 pulley trigger finger.

Any traumatic palmar injection trauma must be inspected by a handsurgent right away.