Soft tissue injury: Crush injury, arterial injury, and open fractures

Introduction A crush injury occurs when a limb is compressed, resulting in direct tissue injury and disruption of vascular supply that may lead to tissue necrosis, muscle swelling, and neurological disturbances. The severity of injury is directly related to the force applied to an extremity and to the degree and duration of the compression. Approximately 85% of arterial injuries are caused by penetrating trauma, which tends to be more discrete or focal. The most common vessels involved are the popliteal and femoral arteries in the lower extremity and the brachial and axillary arteries in the upper extremity. Open fractures are complex injuries of not only bone but the surrounding neurovascular structures. The communication with the outside world results in contamination and the gross deformity may result in compromised vascular supply. This combination places the wound at very high risk of infection and wound healing complications. Table 14.1 gives a classification of fractures with soft tissue injuries.