![]() On the other hand, although compartment syndrome and crush syndrome are considered part of the same disease spectrum, they are different, and fasciotomy is not considered the first-line treatment for crush syndrome. While successful results have been reported in fasciotomy performed before 6–12 h, which is called early fasciotomy, generally poor results have been reported in late fasciotomy. On the one hand, compartment syndrome is considered a surgical emergency in which fasciotomy is the only treatment because muscle necrosis can occur if the intracompartmental pressure rises more than 30 mm Hg for more than 8 h. The indication and timing of fasciotomy in crush injury are controversial. Therefore, early amputations may save lives, and survival chances should not be compromised by desperate and inefficient attempts to save a limb ![]() This muscle necrosis is also a source of infection, sepsis, and death. In patients with crush injury, severely traumatized limbs with tissue necrosis are a potential source of myoglobin and potassium release into the circulation. The primary goal of treatment in crush injury should be to save lives, secondly, to preserve limb function. A value of p < 0.05 was accepted as statistically significant for all tests. IBM SPSS 20.0 (Armonk, New York, IBM Corp.) was used for all statistical analyses. ![]() To compare more than two groups, the Kruskal–Wallis test was employed. Mann–Whitney U test was used to compare continuous variables between two groups. The Kolmogorov–Smirnov test was used to confirm the normality of the distribution for continuous variables. To compare categorical variables between the groups, the chi-square test was performed. While continuous variables were summed up as mean, standard deviation, median, and quartiles (Q1–Q3), categorical variables were expressed as numbers and percentages. We could not do long-term follow-ups of the patients. On the 15th day after the disaster, the patients were transferred to other health institutions. Our hospital was damaged after the earthquakes, and the main buildings were evacuated on. The mortality rates of the groups were compared. The second group is those with lower limb crush injuries other than the thigh, the third group is unilateral thigh or unilateral thigh plus other parts, and the fourth group is bilateral thigh or bilateral thigh plus other limb parts. The first group is those who do not have crush injuries in their lower extremities. For this reason, patients with lower limb injuries with crush syndrome were divided into four groups according to the parts of the affected limb. This led us to the misconception that the crush syndrome clinic was severe in foot and leg injuries. When the thighs were crushed, the legs and feet were affected secondary to ischemia. In this patient group, the effects of trapped time, affected limb parts, surgical procedures on CK concentration, dialysis requirement, and mortality were examined. For the final evaluation, 233 patients with crush syndrome were included. Among the patients, those with a CK concentration below 1000 U/L, which is an indicator of rhabdomyolysis, were excluded from the study. Patients who admitted after the 7th day of the disaster and had a hospitalization period of less than a day were excluded from the study. Patients admitted to our hospital in the first week after the disaster were included in the study. We aimed to determine the development of crush syndrome, dialysis requirement, and CK concentration according to the crushed limb parts. Amputation is life-saving, especially in desperate lower extremity injuries. Late fasciotomy should not be preferred in crush syndrome. Thigh injury is associated with the severity of crush syndrome and mortality. 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). Mortality was significantly increased in patients with thigh injuries ( p = 0.028). Lower extremity injury, abdominal trauma, and thoracic trauma were associated with mortality. One hundred and two patients (56.7%) underwent hemodialysis. Fasciotomy and amputation were performed in 41 (17.6%) and 72 (30.9%) patients. The mean time under the rubble was 41.89 ± 29.75 h. Demographic data, physical and laboratory findings, surgical treatments, and outcomes were recorded. Totally, 233 crush syndrome patients were included. The clinical data of patients during their first week of hospitalization were analyzed retrospectively. 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. The decision of fasciotomy or amputation in crush syndrome is controversial and challenging for surgeons.
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