World Journal of Surgery

, Volume 16, Issue 5, pp 899–903 | Cite as

Crush injury and crush syndrome

  • Moshe Michaelson
World Progress In Surgery

Abstract

Crush injury is caused by continuous prolonged pressure on the limbs. It is found in patients extricated after being trapped for at least 4 hours. The main injury is to the muscles of the limbs. Treatment should be conservative and fasciotomy should be avoided. If fasciotomy is performed, it should be followed by radical debridement of the injured muscle in an attempt to avoid infection of the injured limb. Infection endangers the patient's life and is the main cause of morbidity and mortality today. The outcome of conservative local treatment of crush injury is much superior to that of operative treatment. The pathophysiology of crush injury is not fully understood and no good animal model is known. Crush syndrome, which is the general manifestation of crush injury, is better understood. If not prevented, it will lead to acute renal failure. A method for preventing acute renal failure is discussed and a protocol is described. There is no doubt that prevention of acute renal failure is the goal in the treatment of crush syndrome and can be achieved.

Keywords

Acute Renal Failure Crush Injury Injured Muscle Radical Debridement Good Animal Model 

Résumé

Les lésions par écrasement sont définies comme celles provoquées par une compression prolongée des membres. Elles se voient surtout lorsqu'une victime a été ensevelie pendant au moins 4 heures. La lésion principale intéresse les muscles. Le traitement doit être conservateur et il faut éviter l'aponévrotomie. Toutefois, si une aponévrotomie doit être effectuée, il faut pratiquer une excision complète de tous les tissus blessés afin de prévenir l'infection. L'infection en effet est un facteur de pronostic vital et constitute de nos jours la cause principale de mortalité et de morbidité. Les résultats du traitement local conservateur des lésions par écrasement sont bien supérieurs à ceux obtenus après traitement chirurgical. La physiopathologie des lésions par écrasement n'est toujours pas complètement élucidée et il n'existe pas de modèle animal satisfaisant. Le crush syndrome, la manifestation générale des lésions par écrasement, est mieux compris actuellement. S'il n'est pas prévenu, il en résulte une insuffisance rénale aiguë. La meilleure façon à prévenir ceite insuffisance est discutée et un protocole est décrit. It n'existe pas de doute que la prévention de l'insuffisance rénale doit être le but du traitement du crush syndrome et peut souvent être atteint.

Resumen

Las lesiones de machacamiento son causados por presión continua y prolongada sobre una extremidad. Con frecuencia se encuentran en pacientes queise resctan después de estar atrapados por no menos de 4 horas. La injuria principal ocurre en los músculos de la extremidad afectada. El tratamieno debe ser conservador y la fasciotomía debe ser evitada, por el riesgo de sangrado y de infección. Si se practica fasciotomía, ésta debe acompañarse de desbridamie to radical de los músculos lesionados con el objeto de evitar infección en el miembro traumatizado. La infección puede poner en peligro la vida del paciente, y hoy en día constituye la principal causa de morbilidad y mortalidad. El resultado final del tratamiento conservador local es muy superior al del tratamiento operatorio. La fisiopatología de la lesión de machacamiento no ha sido totalmente dilucidada y no se dispone de un buen modelo animal para su estudio. El síndrome de machacamiento, que representa la manifestación general de la lesión de machacamiento, es mejor conocido; si no se lo previene, da lugar a falla renal anúrica aguda, como resultado de hipovolemia, acidemia y mioglobinemia. Se describe un método para la prevención de la falla renal aguda y se presenta el protocolo correspondiente. No hay duda de que la prevensión de la falla renal aguda es el objetivo del tratamiento del síndrome de machacamiento, y tal objetivo puede ser logrado mediante un manejo racional.

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Copyright information

© Société Internationale de Chirurgie 1992

Authors and Affiliations

  • Moshe Michaelson
    • 1
  1. 1.Emergency DepartmentRambam Medical CenterHaifaIsrael

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