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Compression syndrome
Medical expert of the article
Last reviewed: 07.07.2025
Compression syndrome is formed when soft tissues or internal organs are compressed as a result of a disease with the development of a characteristic clinical picture, which can be regarded as a manifestation of this pathology or as its complication.
Compression syndrome of soft tissues can manifest itself in three forms: crushing, prolonged crushing and positional compression. Pathogenetically, they are united by the formation of traumatic toxicosis and acute renal failure.
Crush syndrome (synonym - "crush syndrome")
The basis is short-term compression of soft tissues of the limbs with great force: pulling into a machine, moving mechanism, pressing with a heavy load, etc. That is, there is crushing of tissues, accompanied by the formation of crushed wounds and open comminuted fractures (78.4%). There may also be closed injuries. But in 83.1% of cases, damage to the neurovascular bundle is noted, which is accompanied by numbness of the limb and its immobility, an increase in volume after release at the scene of the incident. In all cases, traumatic and hypovolemic shock develops. Due to injury to the neurovascular bundle, it is rarely possible to save the limb; in 78.7% of victims, it has to be amputated. If it is preserved, typical renal failure develops from the 2nd-3rd day after the injury due to blockage of the renal tubules with myoglobin lumps. When the patient is connected to hemodialysis, it resolves by the 8th-12th day.
Crush syndrome
The basis is prolonged compression of the limb (more than four hours) with a heavy load. In 76-83% of cases, the injuries are closed: massive muscle crushing with extensive hemorrhages and bone fractures in 49.8% of victims. These are clinical statistics that take into account only survivors. General manifestations in the form of traumatic, by the end of the first day and hypovolemic shock; from the third day, typical renal failure (with hemodialysis, it resolves by the 12th day); autointoxication with peptides and blood slags. Locally: impaired tactile sensitivity with sharp bursting pains; rapidly increasing edema during the day with compression of blood vessels and nerves; limited mobility; formation of blisters with serous or hemorrhagic contents. From the 6th-8th day, muscle necrosis begins, purulent infection joins, often with the development of intoxication.
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Compression syndrome of positional compression
It is formed during prolonged (6-8 hours) compression of a twisted limb (usually the upper one) by one's own body while the victim is in a state of alcoholic or drug-induced sleep. A pronounced but not intense swelling of the limb develops, the pulsation in the arteries decreases moderately, muscle necrosis does not occur, but metabolic acidosis develops and proteolysis products are formed, they cause the development of toxicosis and renal failure, which has the form of a "toxic kidney" and is accompanied only by oliguria.
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Compression syndrome of internal organs
It has a bright specific picture, as it leads to a pronounced dysfunction of the entire system. It can be a manifestation of a disease or injury, but is more often considered as their complication. In clinical practice, the most common are: compression of the brain due to tumors, hematomas, hydrocephalus, edema and swelling of the brain due to injury, inflammation, etc.; compression of the lung by tumors, effusion into the pleural cavity, air or a relaxed diaphragm; pericardium due to injuries and effusions; spinal cord and roots. In case of closed chest trauma, compression of the lungs occurs when the rib cage framework is disrupted by the "floating valve" (anterior or posterior in case of double rib fractures) or "floating chest" type; in case of bilateral rib fractures, pathological movement of a section of the chest wall is observed, with the development of paradoxical breathing and respiratory failure: during inhalation, a section of the chest wall does not bulge, but on the contrary, is drawn into the chest cavity, squeezing the lung; during exhalation, it does not fall in, but is pushed out. In case of "floating chest", such movements are characteristic of the entire anterior section of the chest, and respiratory failure develops very quickly and these movements may not be observed at all due to respiratory arrest.