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53 - Soft Tissue Injury

Crush Injury, Compartment Syndrome, and Open Fractures

from Section 11 - Trauma

Published online by Cambridge University Press:  02 November 2023

By
Katrina Harper-Kirksey
Edited by
Kaushal Shah  and
Jarone Lee
Edited in association with
Clark G. Owyang  and
Benjamin Christian Renne
Kaushal Shah
Affiliation:
Weill Cornell Medical Center, New York
Jarone Lee
Affiliation:
Massachusetts General Hospital, Boston
Clark G. Owyang
Affiliation:
Weill Cornell Medical Center, New York
Benjamin Christian Renne
Affiliation:
Massachusetts General Hospital, Boston
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Summary

  • Severe crush injury can result in sequelae such as significant bony fractures, rhabdomyolysis, extremity compartment syndrome or crush syndrome. Crush syndrome comprises the systemic manifestations that arise as a result of a crush injury followed by reperfusion. From the rupture of muscle cells, substances such as myoglobin, potassium, phosphorus and creatinine phosphokinase are released into the bloodstream. The patient can subsequently develop hyperkalemia, hypocalcemia, hypovolemia, shock, compartment syndrome, lactic acidosis or renal failure from traumatic rhabdomyolysis (seen in up to 40% of patients with crush injury).

Keywords

rhabdomyolysisfracturehyperkalemiafluid resuscitationantibioticswound care
Type
Chapter
Information
Practical Emergency Resuscitation and Critical Care , pp. 567 - 577
Publisher: Cambridge University Press
Print publication year: 2023

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References

Frykberg, ER, Dennis, JW, Bishop, K, et al. The reliability of physical examination in the evaluation of penetrating extremity trauma for vascular injury: results at one year. J Trauma 1991;31(4):502–511.CrossRefGoogle ScholarPubMed
Garner, MR, Sethuraman, SA, Schade, MA, et al. Antibiotic prophylaxis in open fractures: evidence, evolving issues and recommendations. J Amer Acad Ortho Surg 2020;28(8):309–315.CrossRefGoogle ScholarPubMed
Gonzalez, D. Crush syndrome. Crit Care Med 2005;33:S34–41.CrossRefGoogle ScholarPubMed
McQueen, MM, Duckworth, AD. The diagnosis of acute compartment syndrome: a review. Eur J Trauma Emerg Surg 2014;40(5):521–528.CrossRefGoogle ScholarPubMed
Moshe Michaelson, MD. Crush injury and crush syndrome. World J Surgery 1992;16:899–903.CrossRefGoogle Scholar
Sever, MS & Vanholder, R. Recommendations for the management of crush victims in mass disasters. Nephrol Dial Transplant 2012;27(1):i1–i67.CrossRefGoogle ScholarPubMed

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