Treatment Protocol in Crush Injuries

Treatment Protocol in Crush Injuries
Whatever treatment protocol is followed, it should
aim to fulfill the following objectives:
• It should promote primary healing.
• The injured parts should be salvaged.
• It should aim to prevent infection.
The recommended protocol is as follows:
First aid: These measures include covering the wound
with a sterile dressing, hand elevation and judicious
application of a tourniquet if required.
First examination: Here status of the skin is assessed
in sterile conditions without probing the deeper
structures. After the skin, tests are conducted to
assess the damages to bones, tendons and nerves.
Each of these structures should be considered as
damaged until proved otherwise. Radiograph of the
hand and general measures like IV fluids, antibiotics,
etc. is then done.
Second examination: This is the most important step
and is done in a major operation theater under
general anesthesia or a regional block. After a
thorough debridement, all the structures are very
carefully inspected again. Skin is examined for
viability, bones, nerves, tendons; vessels are
inspected for crushing, loss, viability, etc. All the
nonviable structures are excised and loose small
pieces of bones are removed.
If the wound is clean, all the structures are
primarily repaired and the bone is fixed either by
K-wire or Joshi’s external fixators. If the wound is
contaminated, secondary repair of the tendons,
nerves, etc. are planned after 2 to 3 weeks. If the
wound is badly crushed and nonviable, then primary
amputation is considered as discussed above.