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Crush Injury, Compartment Syndrome, and Other Acute Traumatic Ischemias | Print |

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Crush injuries occur when body tissues are severely traumatized such as in motor vehicle accidents, falls, and gun shot wounds.  These injuries frequently occur in the extremities.  When crush injuries are severe, the rate of complications such as infection, non-healing of fractures, and amputations range up to 50%.

When used as an adjunct to orthopedic surgery and antibiotics, hyperbaric oxygen (HBO2) therapy shows promise as a way to decrease complications from severe crush injuries.  HBO2 increases oxygen delivery to the injured tissues, reduces swelling and provides an improved environment for healing and fighting infection.

Hyperbaric oxygen treatments should be started as soon after an injury as possible.  They are usually continued for 5 to 6 days.  A number of related conditions, including compartment syndromes, thermal burns, and threatened replantations are also benefited by hyperbaric oxygen, as discussed in other sections in this site.

References

  1. Bouachour G, Cronier P, Gouello JP, Toulemonde JL, Talha A, Alquier P. Hyperbaric oxygen therapy in the management of crush injuries: A randomized double-blind placebo-controlled clinical trial. J Trauma 1996;41:333-339.
  2. Gustilo R. Management of Open Fractures and their Complications.  W. B. Saunders, Philadelphia 1982;202-208.
  3. Hyperbaric Oxygen Therapy Committee.  Crush injuries, compartment syndromes, and other acute traumatic ischemias.  In: Hyperbaric Oxygen Therapy: 1999 Committee Report. Hampson NB, ed. Undersea and Hyperbaric Medical Society, Kensington, MD 1999;17-21.
  4. Strauss M.  Crush injury, compartment syndrome and other acute traumatic peripheral ischemias.  In: Hyperbaric Medicine Practice.  Kindwall EP and Whelan HT, eds. Best Publishing, Flagstaff, AZ 1999;753-778.

Other references on Crush Injury, Compartment Syndrome, and other Acute Traumatic Ischemias:

 

ACUTE TRAUMATIC PERIPHERAL ISCHEMIA
Note: Within the Medicare 35-10 "Covered Conditions" listing are three conditions for which the rationale for HBO therapy is essentially identical. These conditions involve different etiologies but the net insult will frequently follow the common pathway of :acute ischemia; tissue hypoxia; threatened tissue viability; necrosis; reperfusion injury, and threatened limb loss.
These conditions are:
·         Acute Traumatic Peripheral Ischemia
·         Crush Injuries, and Suturing of Severed Limbs.
·         Acute Peripheral Arterial Insufficiency
As a consequence of this common disease pathway, the supportive literature provided below can serve as representative of all three conditions.

  • Bouachour MD, Cronier P, Gouello JP, ET AL.: Hyperbaric oxygen therapy in the management of crush injuries: A randomized double-blind placebo-controlled clinical trial. The Journal of Trauma: Injury, Infection, and Critical Care 1996; 41(2): 333-339
    A placebo-controlled randomized and blinded clinical trial in acute limb-threatening trauma to the extremities. Statistically significant improvement in outcome occurred in the HBO group. HBO therapy improved wound healing, reduced the number of surgical procedures, and likewise reduced the number of amputations that became necessary.
  • Strauss MB, Hart GB.: Crush injury and the role of hyperbaric oxygen. Topics in Emergency Medicine 1984; 6: 9-24
    An early review article of HBO’s therapeutic impact in crush injury. It predated our knowledge of HBO’s effect on ischemia-reperfusion injury. Consequently, HBO’s role is even more comprehensivet than described herein.
  • Lemperle B: Hyperbaric oxygen therapy for treatment of crush injury and acute traumatic peripheral ischemia. Health Technology Assessment Report 1983, DHHS Publ. No. 84-3372:171-182
    A United States Department Health and Human Services, "Health Technology Assessment Report."
  • Nylander G, Otamiri T, Lewis DH, ET AL.: Lipid peroxidation products in postischemic skeletal muscle and after treatment with hyperbaric oxygen. Scandinavian Journal of Plastic Reconstructive Surgery 1989; 23: 97-103
    Early basic science evidence of a therapeutic effect of HBO therapy in post-ischemia muscle tissue.
  • Skyhar MJ, Hargens AR, Strauss MB, ET AL.: Hyperbaric oxygen reduces edema and necrosis of skeletal muscle in compartment syndromes associated with hemorrhagic hypotension. Journal of Bone and Joint Surgery 1986; 68A: 1218-1224
    Further laboratory evidence of the multi factorial benefits that HBO therapy imparts in acute ischemia/compartment syndrome.
  • Nylander G. Lewis D. Nordstrom H, ET AL.: Reduction of postischemic edema with hyperbaric oxygen. Plastic and reconstructive surgery 1985; 76(4): 596-601
    The consistent laboratory finding of improved outcomes following acute peripheral ischemia and treatment with HBO.
  • Thom SR, Mendiguren I, Hardy K, ET AL.: Inhibition of human neutrophil B2-integrin-dependent adherence by hyperbaric o2. AM J Physiol 1997; 272 (Cell Physiol. 41): C 770-C777
    This paper is included here to demonstrate the depth at which researchers have investigated in order to elucidate HBO’s therapeutic effects in ischemia-reperfusion injury.
  • Strauss MB, Hargens AR, Gershuni DH, ET AL.: Reduction of skeletal muscle necrosis using intermittent hyperbaric oxygen in a model compartment syndrome. The Journal of Bone and Joint Surgery 1983; 65-A: 656-662
    Further basic science to support the clinical application of HBO therapy in acute peripheral ischemias: compelling histological evidence of benefit.
  • Zamboni WA, Roth AC, Russell RC, ET AL.: Morphologic analysis of the microcirculation during reperfusion of ischemic skeletal muscle and the effect of hyperbaric oxygen. Plastic and Reconstructive Surgery 1993; 91(6): 1110-1123
    Using modern-day laboratory techniques, this work provides firm morphologic evidence of the beneficial effect of HBO therapy on microcirculatory perfusion in ischemia-reperfusion injury. HBO therapy is observed to protect the microcirculation from an otherwise post ischemia reperfusion injury.
  • Nylander G, Nordstrom H, Lewis D, ET AL. Metabolic effects of hyperbaric oxygen in postischemic muscle. Plastic and Reconstructive Surgery 1987; 79(1): 91-97
    Sub-cellular evidence of therapeutic effects associated with the application of hyperbaric hyperoxia in post-ischemic muscle tissue. The authors conclude that "Hyperbraic oxygen treatments in the post-ischemic phase stimulate aerobic metabolism."
  • Radonic V, Baric D, Giunio L, ET AL.: War injuries of the femoral artery and vein: A report on 67 cases. Cardiovascular Surgery 1998; 5 (6): 641-647
    A clinical series of war wounded patients. "Hyperbaric oxygen therapy should be used in selected cases in order to improve tissue oxygenation, wound healing, host defense mechanisms, and therapy."
  • Shupak A, Gozal D, Melaned AY, ET AL. Hyperbaric oxygenation in acute peripheral posttraumatic ischemia. Journal of Hyperbaric Medicine 1987; 2 (1): 7-14
    A second clinical series of patients suffering acute post-traumatic limb ischemia. The authors stress the important adjunctive role of HBO therapy.
  • of HBO therapy reduced both morbidity and mortality.

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