Burst Lacerations: A New Term for a Common Injury to the Foot.

Objective: This case series describes four cases with a similar mechanism of injury: crush injuries to the foot from hydraulic presses/trailers. The aim of the study was to review a specific cohort of pneumatic compression injuries of the foot in terms of their soft-tissue component, and in particular relating to the burst lacerations.
Method: The mechanism and patterns of injury were reviewed to identify common features in a case series of four crush injuries to the foot which presented to the Emergency Department of University Hospital Galway over a period of 6 months between January and July 2017.
Results: There were four cases of high-energy crush injuries to the feet seen in involved farmers (mean age 55). The cases presented with similar soft-tissue injuries, despite having quite varied bony injuries. All patients had lacerations of the webbed spaces, which is likely due to extrusion of the interosseous muscles as they are flattened. Three patients had lacerations along the medial side of their foot extending transversely across the plantar surface.
Conclusion: A common pattern of soft-tissue injury was present in these cases. We feel the term "burst laceration" is an appropriate term for describing this pattern. Burst lacerations are a marker of high-energy crush injuries and should alert surgeons to the severe soft-tissue injury that likely overlies the more obvious fracture. The importance of soft-tissue management in high-energy lower limb injury cannot be overstated. We feel the presence of burst lacerations to the foot should alert the surgeon to a high-energy crush-injury type mechanism of injury, and guide both soft-issue and bony management to optimize patient outcomes.