Surgical and critical care management of earthquake musculoskeletal injuries and crush syndrome: A collective review
Fikri M. Abu-Zidan1
, Ali Jawas2, Kamal Idris3, Arif Alper Cevik4
1The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
2Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
3Department of Critical Care and the Intensive Care Unit, Burjeel Royal Hospital, Al-Ain, United Arab Emirates
4Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
Keywords: Acute compartment syndrome, acute kidney injury, critical care, crush syndrome, disaster, earthquake, injury, orthopedics, surgery, trauma
Abstract
Earthquakes are unpredictable natural disasters causing massive injuries. We aim to review the surgical management of earthquake musculoskeletal injuries and the critical care of crush syndrome. We searched the English literature in PubMed without time restriction to select relevant papers. Retrieved articles were critically appraised and summarized. Open wounds should be cleaned, debrided, receive antibiotics, receive tetanus toxoid unless vaccinated in the last 5 years, and re-debrided as needed. The lower limb affected 48.5% (21.9%–81.4%) of body regions/patients. Fractures occurred in 31.1% (11.3%–78%) of body regions/patients. The most common surgery was open reduction and internal fixation done in 21% (0%–76.6%), followed by plaster of Paris in 18.2% (2.3%–48.8%), and external fixation in 6.6% (1%–13%) of operations/patients. Open fractures should be treated with external fixation. Internal fixation should not be done until the wound becomes clean and the fractured bones are properly covered with skin, skin graft, or flap. Fasciotomies were done in 15% (2.8%–27.2%), while amputations were done in 3.7% (0.4%–11.5%) of body regions/ patients. Principles of treating crush syndrome include: (1) administering proper intravenous fluids to maintain adequate urine output, (2) monitoring and managing hyperkalemia, and (3) considering renal replacement therapy in case of volume overload, severe hyperkalemia, severe acidemia, or severe uremia. Low-quality studies addressed indications for fasciotomy, amputation, and hyperbaric oxygen therapy. Prospective data collection on future medical management of earthquake injuries should be part of future disaster preparedness. We hope that this review will carry the essential knowledge needed for properly managing earthquake musculoskeletal injuries and crush syndrome in hospitalized patients.
How to cite this article: Abu-Zidan FM, Jawas A, Idris K, Cevik AA. Surgical and critical care management of earthquake musculoskeletal injuries and crush syndrome: Acollective review. Turk J Emerg Med 2024;24:67-79.
Data of the review are publicly published data. The study does not require ethical approval.
All authors have contributed to the idea. Fikri M. Abu‑Zidan supervised the project, did the literature search, retrieved the literature, critically read and wrote sections on surgical management, organized the structure of the manuscript, and repeatedly edited the manuscript. Ali Jawas critically read and wrote the section on the diagnosis of ACS. Kamal Idris critically read and wrote the section on the management of AKI. Arif Cevik Alper critically read and wrote the section on the management of Crush Syndrome in the Emergency Department and drew Figures 3 and 4. All authors approved the last version of the manuscript.
None Declared.
None.
The authors thank Dr Nawaf Jurdi, Pathologist, Department of pathology and laboratory medicine, American University of Beirut, Lebanon, for reviewing the modifications of Figure 1.