A case of non-union of the medial cuneiform

Abstract

Emergency creatinine phosphokinase assay should be considered in the immediate assessment of any injury involving a crushing force. Serial assessment of the enzyme in association with compartment pressure monitoring is useful if neurological injury precludes accurate clinical assessment of a limb. It can also be of value in directing surgical management when the response to haemodialysis is compromised. In Case z the extent of the muscle damage in the thigh was not appreciated initially, and in retrospect revascularization of seriously injured muscle may well have contributed to the degree of crush syndrome which developed. When a vascular injury is combined with extensive loss or damage to muscle compartments, great vigilance is required and early amputation may be necessary. The decision to perform fasciotomy in a closed crushed limb has to take account of the high risk of infection, both locally and systemically increased by impending or established renal failure. Avoidance of fasciotomy in such patients is recommended by Reis and Michaelson (1986) except where survival of the limb is in question. Such advice proved appropriate in Case 3. The association between delay in treatment and increased morbidity is common to both crush and compartment syndromes. There can be no excuse for delay in such conditions, which can easily be diagnosed and effectively treated. References