MORBIDITY AFTER CRUSH INJURIES TO THE FOOT

By retrospective review of hospital records and by follow-up clinical examinations, we evaluated 58 patients with crush injuries to the foot treated at our institution between 1986 and 1990. All patients had re ceived initial treatment according to a standardized protocol determin ed by the type and magnitude of the injury. Patients were examined at a mean interval of 3.3 years (range 2-4) after injury, and the functio nal outcome was determined according to a foot trauma rating scale. Ba sed on this scoring system, 46% of the patients had good functional ou tcome, 29% had fair results, and 25% had poor results. There was a sig nificant correlation between a good functional outcome and careful adh erence to the treatment protocol; however, some patients fared poorly regardless of treatment. Poor results occurred if treatment was not im mediately initiated, if soft-tissue coverage was delayed (in those who experienced severe, mangling-type injuries necessitating partial foot amputation), if patients subsequently had neuritis or reflex sympathe tic dystrophy, or if patients were involved in ongoing workers' compen sation and litigation. We conclude that because crush injuries of the foot may be associated with prolonged morbidity, initial management sh ould be directed toward recognition and treatment of compartment syndr omes, early soft-tissue coverage, and rigid skeletal stabilization to enhance soft-tissue healing.