Crush Syndrome — Pathophysiology, Management and Complications
DNB Orthopaedics • May 2024 • Paper I • 10 Marks
Introduction
Crush syndrome is the systemic manifestation of severe skeletal-muscle injury caused by prolonged compression, resulting in rhabdomyolysis and release of intracellular muscle contents into the circulation.
The major life-threatening consequences are hyperkalemia, hypovolemic shock, metabolic acidosis, myoglobin-induced acute kidney injury, cardiac arrhythmia and multiorgan failure.
The most dangerous period may begin after release of the crushed limb, when potassium, myoglobin, acids and other intracellular products suddenly enter the circulation.
Definition
Crush syndrome is a systemic illness resulting from traumatic rhabdomyolysis due to prolonged compression of a large muscle mass, followed by metabolic, circulatory and renal consequences after reperfusion.
It should be differentiated from a simple crush injury, which may remain localized without systemic manifestations.
Common Causes
- Building collapse and earthquakes
- Industrial accidents
- Road-traffic accidents with entrapment
- Heavy-object compression
- Prolonged limb compression in an unconscious patient
- Prolonged immobilization after intoxication or seizures
- Severe compartment syndrome
A. Pathophysiology
Prolonged muscle compression
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Local ischemia + direct mechanical injury
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ATP depletion
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Failure of Na⁺/K⁺ and Ca²⁺ pumps
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Intracellular Na⁺ and Ca²⁺ accumulation
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Cell swelling + protease/phospholipase activation
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