title: Necrosis of the 4th and 5th digits after intra-articular injection of diazepam into the wrist.
abstract: A 75-year-old woman presented with progressing pain, cyanosis, and hypaesthesia in her left hand after an intra-articular injection with diazepam into the wrist for osteoarthritis-related pain. Due to an iatrogenic intra-arterial injection, malperfusion of the ulnar digits developed. Angiography revealed blockage of perfusion of the 4th and 5th digits. Despite intra-arterial lysis, heparinisation, and vasodilatation, perfusion could not be reinstalled. Necrosis of the distal phalanges of the 4th and 5th digits developed, which had to be treated with amputation. The pathomechanism of tissue damage and the treatment options after intra-arterial injections are reviewed and discussed.
authors.affiliation: Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Hugstetter Straße 55, 79106 Freiburg, Germany.
authors.forename: Niklas
authors.initials: N
authors.lastname: Iblher
authors.forename: Gerd Bjoern
authors.initials: GB
authors.lastname: Stark
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Penna