Crush Injuries and Compartment Syndrome
Crush Injuries
Crush injuries can cause soft tissue trauma but may also feature open wounds, broken bones, nerve injury, and vascular damage. Surgery can be employed to stabilise fractures and to repair nerves and vessels, but there are no surgical interventions that address tissue damage at the microvascular level. The trauma from the crush injury causes swelling (oedema), reducing the amount of oxygen able to get to the damaged tissues and causing further injury.
HBO has been used to counteract this phenomenon and increase oxygenation to the damaged tissues thus increasing the chance of healing.
Compartment syndrome
Compartment syndrome is a complication of a crush injury where bleeding occurs in the muscle compartment. This compartment is a fixed space and does not expand therefore, if the bleeding continues, the pressure can cause damage to the muscles and nerves. Surgery is used to relieve this pressure before the muscles and nerves die.
In some studies, HBO has been used when compartment pressures were elevated but before surgery was indicated, allowing for recovery before surgery was required. Therefore, in patients where compartment syndrome is a risk but not yet established, the early addition of HBO may be considered.
In both crush injuries and compartment syndrome HBO treatment is decided on a case by case basis.
Information on Referral & Funding can be found here.
References
Buettner MF, Wolkenhauer D. Hyperbaric oxygen therapy in the treatment of open fractures and crush injuries. Emerg Med Clin North Am. 2007 Feb;25(1):177-88. doi: 10.1016/j.emc.2007.01.008. PMID: 17400080.
Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med. 2017 Mar;47(1):24-32. doi: 10.28920/dhm47.1.24-32. Erratum in: Diving Hyperb Med. 2017 Jun;47(2):131-132. doi: 10.28920/dhm47.2.131-132. PMID: 28357821; PMCID: PMC6147240.
Van Poucke S, Leenders T, Saldien V, Verstreken J, Beaucourt L, Adriaensen H. Hyperbaric oxygen (HBO) as useful, adjunctive therapeutic modality in compartment syndrome. Acta Chir Belg. 2001 Mar-Apr;101(2):73-4. PMID: 11396055.