Crush Syndrome — Etiopathogenesis, Clinical Features and Management
DNB Orthopaedics • October 2024 • Paper I • 10 Marks
Introduction
Crush syndrome is a potentially fatal systemic complication of prolonged compression and destruction of skeletal muscle. It is most commonly seen after earthquakes, building collapse, road-traffic accidents, industrial injuries and prolonged entrapment.
The major systemic consequences result from rhabdomyolysis, hypovolaemia, hyperkalaemia, metabolic acidosis and myoglobin-induced acute kidney injury.
Definition
Crush syndrome is the systemic manifestation of severe traumatic rhabdomyolysis following prolonged compression of a large muscle mass, characterised principally by shock, electrolyte disturbances and acute kidney injury.
Crush Injury vs Crush Syndrome
| Term | Meaning |
|---|---|
| Crush injury | Local tissue damage caused by compression of a body part |
| Crush syndrome | Systemic metabolic and circulatory consequences of extensive muscle destruction |
Etiology
- Earthquake and building-collapse victims
- Road-traffic accidents with entrapment
- Industrial or mining accidents
- Heavy-object compression of limbs
- Prolonged unconsciousness or immobilisation
- Prolonged limb compression in drug/alcohol intoxication
- Severe limb trauma with extensive muscle destruction
Etiopathogenesis
Prolonged compression compromises muscle microcirculation, causing ischaemia and direct mechanical destruction of myocytes.
1. Cellular Injury
Ischaemia reduces ATP…