A Guide To Treating Crush Injuries

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Here is a view of the surgeon measuring the compartment pressures of the foot in a patient who sustained a bulldozer crush injury.
Two dorsal incisions were used to decompress the adductor and the four interosseous compartments.
The authors used a medial-plantar incision to decompress the medial, lateral, superficial and calcaneal compartments.
This patient sustained an open crush injury to the talus when a railroad beam fell on his foot.
The patient underwent debridement with talectomy and external fixation. A muscle flap was used to cover the soft tissue defect. A tibiocalcaneal arthrodesis will follow.
This patient sustained a Lisfranc’s fracture dislocation with disruption of the midtarsus and an impaction “nutcracker” fracture of the cuboid after being involved in a boating injury.
This injury was open reduced and internally fixated. An external fixation device was used to span the cuboid fracture and maintain length.
This patient sustained a severe crushing injury to the distal tibia and fibula as well as his entire foot. The injury occurred when a 3,000 lb. steel beam fell on his lower leg.
This patient had poor vascular status to his foot. He was temporarily fixated with pins while his foot was closely monitored. He eventually required a below-knee amputation due to the severity of the trauma.
By Zach J. Tankersley, DPM, Robert W. Mendicino, DPM, Alan R. Catanzariti, DPM, and Jordan P. Grossman, DPM

Additional References
58. Papa J, Myerson M: Split-thickness skin excision for crush and degloving injuries of the foot. Perspect Orthop Surg 2: 77-85, 1991.
59. Mubarak S, Owen C: Compartmental syndrome and its relation to the crush syndrome. A spectrum of disease. A review of 11 cases of prolonged limb compression. Clin Orthop 113: 81-89, 1975.
60. Myerson M, Burgess A: The initial evaluation and treatment of the acutely traumatized foot and ankle. In: Jahss M, ed. Disorders of the foot and ankle: medical and surgical management. 2nd edition. Philadelphia: W.B. Saunders; 2209-32, 1991.
61. Grodinsky M: A study of the fascial spaces of the foot and their bearing on infections. Surg Gyn Obst 49: 737-751, 1929.
62. Ziv I, Zeligowski A, Mosheiff R, Lowe J, Wexler M, Segal D: Split-thickness skin excision in severe open fractures. J Bone Joint Surg Am 70: 23-26, 1988.

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