Crush Injury of the Limbs and Acute Mechanical Muscle-Crush Compartment Syndrome

Abstract

A high-energy injury to a limb not only tears, disrupts, and causes tissue loss but often conceals an occult crushed muscle tissue mass, especially when a powerful blast force has acted on the wound. In this open crush wound (OCW) it is difficult to define the border between living and dead muscle. Another type of crush injury of a limb is the closed crush, typical of casualties crushed under masonry, vehicles, or victims lying unconscious without movement for many hours (mechanical muscle-crush injury – MMCI). An extensive muscle-crush injury culminating in a crush syndrome is often lethal unless treated aggressively and promptly [1]. The systemic causes of death in MMCI are: hypovolemic shock, hyperkalemia, hypocalcemia, metabolic acidosis, and acute myoglobinuric renal failure. This series of events begins with dehydration and is followed by the dangers of the reperfusion of the crushed tissues of the limb. The local causes of morbidity and mortality are the acute muscle-crush compartment syndrome complicated by overwhelming sepsis, often after fasciotomy, and gas gangrene in neglected open crush wounds.