High-pressure water injection injuries of the hand are uncommon, and there is limited literature to guide their treatment. The ideal management of these injuries, whether nonoperative with close observation or early surgical debridement, remains unknown. The authors retrospectively identified a cohort of patients with high-pressure water injection injuries to the hand during a 16-year period. Data collected included demographics, location of injection, hand dominance, type of treatment, need for additional surgery, and complications. The authors attempted to reach all patients by phone and email to assess long-term motion loss, sensation loss, and chronic pain. Nineteen patients met the inclusion criteria. The nondominant hand was involved in 84% and the index finger in nearly half. Two of 10 patients in the early surgery group required additional procedures, including a trigger finger release and serial debridements for Pseudomonas infection. Three of 9 patients without early debridement eventually required surgery, including debridement of a septic flexor tenosynovitis, fingertip amputation, and metacarpophalangeal disarticulation. Sixteen percent of patients developed infection, and 1 patient developed compartment syndrome. This is the largest reported cohort of both operatively and nonoperatively treated high-pressure water injection injuries to the hand. This is the first report of amputation as a complication. Infection and delayed presentation portend a poor outcome. Complications may arise even after early surgical debridement, and long-term sequelae are common. These injuries are not inherently benign and warrant immediate medical attention, early antibiotics, and a low threshold for close observation or surgical debridement. [Orthopedics. 2018; 41(2):e245-e251.].
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