When a part of the body is caught between two objects that are being pushed together by a high pressure, the resulting squeeze will leave that person with a crush injury. Most often accidental, crush injuries are responsible for broken bones, severe bruising, bleeding, lacerations and compartment syndrome. Crush injuries are common in car accidents, falls and in any situation that can lead to a structure collapsing. But there are also varying degrees of crush injuries, from slamming a finger in a door to limbs being trapped and crushed for an extended period of time.
Depending on the severity of the crush injury, the symptoms will differ. For a minor injury (i.e. a finger in a door or dropping something on a toe) there can be bruising, lacerations and moderate pain. However, the recovery time is significantly shorter than a major crush injury, as is the degree of the symptoms. In the case of a major crush injury, there is often serious damage below the skin, including tissues, organs, muscles and bones. A crush injury will often cut off the flow of blood in the damaged appendage, leading to serious muscle and tissue damage, as well as numbness and possible paralysis. There is also a much greater chance for infection in the damaged tissues and muscles. The force of the impact can also cause serious damage to the skin, in some cases completely removing layers and leaving the wound exposed to infection and deformity. Infection can lead to amputation in extreme cases.
In many cases of crush injuries, compartment syndrome will take place. When the muscles and tissues are deprived of blood for too long after a crush injury accident occurs, there is a strong chance that the nerves will become severely damaged and the victim will experience muscle death. While most common in crush injuries to the legs, compartment syndrome can occur in any part of the body that is crushed and trapped between two objects for too long. When compartment syndrome is settling in, the first sign is extreme pain, followed by the tingling sensation of “pins and needles” that a limb experiences when it is “asleep” and then eventually paralysis of the limb. Once the paralysis has set in, the pulse will be nonexistent in the affected limb. A visual sign of compartment syndrome is swollen skin with a shiny appearance.
In the case of minor crush injuries, medical attention shouldn’t be necessary. Simply clean the wound with fresh water, especially if bleeding is present, to avoid infection. Apply ice to the point of injury and keep it compressed to alleviate pain. Should there be considerable swelling and limited or no mobility in the affected extremity, medical attention may be necessary in order to obtain an X-ray and determine if there is a break. Fractures are often a cause of compartment syndrome.
If the wound is considerably greater with moderate to heavy bleeding, immediate medical attention is required, and a tetanus shot will be necessary, as well as other antibiotics. In serious crush injuries, in which compartment syndrome has already set in or is inevitable, immediate surgery (most likely a fasciotomy) will be required to eliminate the pressure on the muscles and nerves. If the injury is not treated immediately, and compartment syndrome exists for considerable time, then amputation may be required.
Many cases of serious crush injury will require multiple surgeries to complete nerve and tendon repairs.
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