6 February 2023, Orthopedic experience in Kahramanmaras Earthquake and surgical decision in patients with crush syndrome

Abstract Background: The decision of fasciotomy or amputation in crush syndrome is controversial and challenging for surgeons. We aimed to share our experiences after the Kahramanmaraş Earthquake, to predict the severity of crush syndrome and mortality, and to guide the surgical decision. Methods: The clinical data of patients during their first week of hospitalization were analyzed retrospectively. Totally 233 crush syndrome patients were included. Demographic data, physical and laboratory findings, surgical treatments, and outcomes were recorded. Results: The mean time under the rubble was 41.89±29.75 hours. Fasciotomy and amputation were performed in 41 (17.6 %) and 72 (30.9%) patients. One hundred and two patients (56.7%) underwent hemodialysis. Fifteen patients (6.4%) died. Lower extremity injury, abdominal trauma, and thoracic trauma were associated with mortality. Mortality was significantly increased in patients with thigh injuries (p=0.028). The mean peak CK concentration was 69.817,69 ± 134.812,04 U/L. Peak CK concentration increased substantially with amputation (p=0,002), lower limb injury (p<0.001), abdominal trauma (p=0.011), and thoracic trauma (p=0.048). Conclusions: Thigh injury is associated with the severity of crush syndrome and mortality. Late fasciotomy should not be preferred in crush syndrome. Amputation is life-saving, especially in desperate lower extremity injuries.