From the Research
Yes, a crush injury without fracture can cause subcutaneous emphysema, as significant soft tissue damage can create pathways for air to enter subcutaneous tissues, even in the absence of a bone fracture 1. Subcutaneous emphysema occurs when air or gas becomes trapped beneath the skin, creating a characteristic crackling sensation upon palpation called crepitus.
Pathophysiology and Causes
In crush injuries, the crushing force can create tears in structures connected to air-containing spaces, such as the lungs, airways, or gastrointestinal tract. For example, a crush injury to the chest may damage lung tissue without breaking ribs, allowing air to escape from the lungs into surrounding tissues. Similarly, crush injuries near the face or neck might damage the pharynx or trachea, permitting air leakage.
Management and Complications
Management involves treating the underlying cause, monitoring for progression, providing supplemental oxygen if needed, and sometimes placing chest tubes for significant pneumothorax cases. While subcutaneous emphysema often resolves on its own once the air leak stops, patients should be monitored for complications like infection or respiratory compromise, especially when the emphysema is extensive or rapidly expanding 2.
Clinical Considerations
Emergency clinicians should be aware of the potential for subcutaneous emphysema in patients with crush injuries, even in the absence of a fracture, and have a low threshold for rapid referral to an appropriate surgical specialty for prompt and radical surgical management if necessary 3. The most recent and highest quality study on crush injury and syndrome highlights the importance of understanding the pathophysiology, evaluation, and management of these conditions to optimize patient care 1.
Key Points
- Crush injuries can cause subcutaneous emphysema even without a fracture
- Significant soft tissue damage can create pathways for air to enter subcutaneous tissues
- Management involves treating the underlying cause and monitoring for complications
- Patients should be monitored for infection or respiratory compromise, especially with extensive or rapidly expanding emphysema
- Emergency clinicians should have a low threshold for referral to a surgical specialty for prompt management if necessary 3, 1