What Is Crush Injury?

  • Berk Toy Bachelor of Medicine, Bachelor of Surgery - MBBS, Medicine, Marmara University
  • Ellen Rogers MSc in Advanced Biological Sciences, University of Exeter

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Introduction

Accidents can happen when you least expect them, and sometimes they can result in injuries that are not only painful but serious. One such injury is a crush injury, which can occur in various situations. In this article, we will explore what a crush injury is, its causes, symptoms, and the medical details behind this type of injury.

Understanding crush injuries 

By definition, a crush injury occurs when one or multiple body part(s) are subjected to a significant amount of pressure or force, often resulting in damage to muscles, blood vessels, nerves, and other tissues.1 Crush injuries can vary in severity from minor to life-threatening, depending on factors like the force and duration of the compression and the body part(s) affected. Understanding the nature of crush injuries is essential for recognising their signs and symptoms and seeking appropriate medical care.

Causes of crush injuries

Accidents

Accidents are one of the leading causes of crush injuries. These accidents can happen in various settings, including:

  • Automobile accidents: Collisions on the road can lead to crush injuries when vehicles are impacted, especially in severe accidents2
  • Industrial incidents: In workplaces where heavy machinery and equipment are used, there is a risk of crush injuries if someone becomes trapped or pinned underneath them3
  • Home-related accidents: Everyday situations can also result in crush injuries. For example, heavy objects falling on a person while at home can cause significant harm4

Natural disasters

Natural disasters, such as earthquakes and hurricanes, can lead to crush injuries. The force of these events can cause structures to collapse, trapping individuals beneath debris.5

Sports and recreational activities

Crush injuries can also occur during sports, both recreational and competitive. Such scenarios include:

  • Contact sports: Athletes participating in contact sports, like football or rugby, may experience crush injuries during tackles or collisions6
  • Outdoor activities: Hikers, climbers, and adventurers may suffer crush injuries if they become trapped under rocks or other heavy objects7

Understanding the potential causes of crush injuries is essential for taking preventive measures and being prepared in case of emergencies.

Common symptoms of crush injuries

Recognising the symptoms of crush injuries is crucial for seeking timely medical attention, as crush injuries (and their impacts) can vary in severity. Common symptoms of crush injuries include:

  • Pain: One of the most common and immediately obvious symptoms of a crush injury is intense pain at the injury site.1 This pain can be debilitating and may worsen with movement
  • Swelling and bruising: Crush injuries often result in localized swelling and bruising due to tissue damage and bleeding.2 The affected area may also appear swollen and discoloured
  • Difficulty moving the affected area: Depending on the severity of the crush injury, mobility of the affected area may be impaired. Individuals may find it difficult or impossible to move the injured limb or body part3
  • Numbness or tingling: In some cases, crush injuries can damage or compress nerves, leading to numbness or tingling sensations in the affected area4 
  • Pale or bluish skin colour: A crush injury can disrupt blood flow to affected areas, causing the skin to become pale or bluish in colour.5 This is a sign of compromised circulation and requires immediate attention
  • Weakness: Tissue damage, like that caused by crush injuries, can cause muscle weakness.6 This weakness can make it difficult for the injured person to move or use the affected body part

It's important to note that the severity and combination of these symptoms can vary from one crush injury to another. In some cases, the symptoms may be subtle, while in others, they can be quite pronounced. If you or someone you know experiences these symptoms after being crushed, it is crucial to seek immediate medical attention. Crush injuries can lead to complications such as infection, compartment syndrome, or long-term muscle damage if not treated promptly.

Medical details of crush injuries

Direct compression

The primary mechanism behind a crush injury is the direct compression of body tissues between two hard surfaces.1 This compression can cause significant damage to muscles, blood vessels, nerves, and other tissues in the affected area.

Ischemia-reperfusion injury

The rapid release of pressure after a heavy object is lifted off an injured limb can lead to reperfusion injury.8 Reperfusion injuries occur when the return of blood flow causes further damage to crushed areas due to oxidative stress. As such, reperfusion injuries can exacerbate the tissue damage and inflammation caused by crush injuries.

Compartment syndrome

In some cases, crush injuries can lead to compartment syndrome, where increased pressure within a muscle compartment impairs the blood flow and nerve function within it.9 This condition can be serious and may require surgical intervention to relieve the pressure.

Rhabdomyolysis

Crush injuries can result in the breakdown of muscle tissue, a condition known as rhabdomyolysis.10 When muscle cells break down, they release a protein called myoglobin into the bloodstream. High levels of myoglobin in the blood can lead to kidney damage and other complications if not treated promptly.

Nerve damage

The compression and trauma associated with crush injuries can cause nerve damage.11 This can result in sensory and motor deficits in the affected area and may require specialized medical care.

Understanding these medical details can help individuals and healthcare professionals better assess and manage crush injuries. It's crucial to seek prompt medical attention when crush injuries occur to prevent these complications and work towards the best possible outcome.

Treatment of crush injuries

Pain management

Pain management is a crucial aspect of treating crush injuries. Healthcare professionals may prescribe pain-relieving medications to alleviate the often severe pain associated with these injuries.2 This can be vital in helping improve the patient's comfort and quality of life during the recovery process.

Wound care

If the crush injury has resulted in open wounds or lacerations, proper wound care is essential to prevent infection.12 This includes cleaning the wounds, removing any foreign objects or debris, and applying sterile dressings. Antibiotics may also be prescribed to reduce the risk of infection.

Immobilization

In cases where fractures or dislocations are present, the affected limb or body part must be immobilised.6 This can involve the use of splints or casts to stabilise the injury site and promote proper healing.

Surgery

In severe crush injuries, surgical intervention may be required to repair damaged tissues, blood vessels, or nerves.13 These surgical procedures can be complex and may vary depending on the specific injuries sustained.

Management of Complications

Crush injuries can lead to various complications, including compartment syndrome and rhabdomyolysis. These complications require specialised treatment and monitoring.11 Compartment syndrome may require surgical intervention to release the pressure within affected muscle compartments, while rhabdomyolysis may require fluid resuscitation and other measures to protect the kidneys.

The treatment plan for a crush injury is highly individualised and depends on factors such as the severity of the injury, the body parts involved, and the patient's overall health. Timely medical evaluation is crucial to assess the extent of the injury and determine the most appropriate course of action.

Preventive measures for crush injuries

Safety gear and equipment

  • Use appropriate safety gear: Whether at work or in recreational activities, always use the recommended safety equipment, such as helmets, seatbelts, and protective gear14
  • Inspect safety gear: Regularly inspect safety gear and equipment for any signs of damage or wear, and replace as needed

Proper lifting techniques

  • Learn proper technique: When lifting heavy objects, use proper lifting techniques to minimize the risk of strain or accidents.15 Bend at the knees, keep your back straight, and use your leg muscles to lift
  • Team lifting: For very heavy objects, enlist the help of others to share the load safely

Workplace safety

  • Follow safety protocols: In the workplace, adhere to safety protocols and guidelines to prevent accidents.4 Attend safety training programs and be aware of potential hazards within your workplace
  • Machine safety: If working with heavy machinery or equipment, follow all safety procedures and guidelines, and use protective barriers where necessary

Home safety

  • Secure heavy objects: At home, ensure that heavy objects are securely stored and not at risk of falling or toppling over16
  • Childproofing: If you have young children, childproof your home to prevent accidents involving heavy objects or furniture

Vehicle safety

  • Safe driving practices: Practice safe driving habits, obey traffic laws, and avoid risky behaviours to reduce the risk of automobile accidents17
  • Seatbelt use: Always wear your seatbelt when in a vehicle, and make sure all passengers do the same

Summary

Preventing crush injuries requires a combination of awareness, education, and proactive safety measures. By taking preventative steps and making safety a priority in your daily life, you can significantly reduce the risk of crush injuries for yourself and those around you.

Thank you for joining us on this educational journey about crush injuries. Stay safe and take the necessary precautions to protect yourself and others from these potentially severe injuries.

References

  1. Zafren K. (2020). Crush Injuries. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538227/.
  2. American Association for the Surgery of Trauma. (n.d.). Crush Injury. Retrieved from https://www.aast.org/resources-detail/crush-injury.
  3. Occupational Safety and Health Administration. (2021). Crushed-Hand Protection. Retrieved from https://www.osha.gov/oshanswers/safety_haz/crushed.html.
  4. Safe Work Australia. (2021). Preventing Crush Injuries in the Workplace. Retrieved from https://www.safeworkaustralia.gov.au/crushed.
  5. Centers for Disease Control and Prevention. (2021). Earthquake Safety. Retrieved from https://www.cdc.gov/disasters/earthquakes/preparedness.html.
  6. American Academy of Orthopaedic Surgeons. (2021). Sports Injuries. Retrieved from https://orthoinfo.aaos.org/en/staying-healthy/sports-injuries.
  7. Outdoors Victoria. (2021). Safety and Risk Management. Retrieved from https://outdoorsvictoria.org.au/safety-risk-management/.
  8. Ongaro S, Bukholm G, Grottum P, Aasen AO, Stangeland L. (1997). Crush injury of the hind limb in rats as a model for studying the response of different cell types to local hypoxia and reoxygenation. Retrieved from https://pubmed.ncbi.nlm.nih.gov/9232205/.
  9. Velmahos GC, Theodorou D, Demetriades D, et al. (1998). Complications and nonclosure rates of abdominal fascial defects in acute trauma. Retrieved from https://pubmed.ncbi.nlm.nih.gov/9710425/.
  10. Okumura T, Nagamoto S, Inada H, et al. (2021). Risk Factors for Rhabdomyolysis and Secondary Acute Kidney Injury in Trauma Patients. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34344790/.
  11. Centers for Disease Control and Prevention. (2021). Crush Injuries and Deaths Related to the 12 January 2010 Earthquake in Haiti. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5908a1.htm.
  12. American Red Cross. (2021). Crush Injury. Retrieved from https://www.redcross.org/take-a-class/crush-injury.
  13. American College of Surgeons. (2019). Management of Crush Injuries. Retrieved from https://www.facs.org/media/press-releases/2019/crush062019.
  14. Occupational Safety and Health Administration. (2021). Preventing Injuries and Deaths of Workers Who Operate or Work Near Forklifts. Retrieved from https://www.osha.gov/publications/forklift-safety-pocket-card.
  15. Health and Safety Executive. (2021). Getting to Grips with Manual Handling: A Short Guide. Retrieved from https://www.hse.gov.uk/pubns/indg143.htm.
  16. Safe Kids Worldwide. (2021). Preventing Furniture and TV Tip-Overs. Retrieved from https://www.safekids.org/tip/furniture-and-tv-tip-overs17. National Highway Traffic Safety Administration. (2021). Vehicle Safety. Retrieved from https://www.nhtsa.gov/vehicle-safety.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Berk Toy

Meet Berk Toy, a graduate of Marmara University School of Medicine, on a mission to simplify health. With a background spanning Turkey and the UK, Dr. Toy is both a trusted GP assistant and a dedicated medical interpreter. Join him as he breaks down complex medical concepts, empowering you to lead a healthier, happier life.

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