Mechanical muscle-crush injury and acute muscle-crush compartment syndrome: with special reference to earthquake casualties.

©2005 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.87B4. 15334 $2.00 J Bone Joint Surg [Br] 2005;87-B:450-3. An extensive muscle-crush injury culminating in a crush syndrome is often lethal unless treated actively and promptly. The causes of death in crush syndrome include hypovolaemic shock, hyperkalaemia, hypocalcaemia, metabolic acidosis, acute myoglobinuric renal failure and the acute muscle-crush compartment syndrome. The incidence of crush syndrome after major earthquakes, which often occur in remote regions, depends upon the unique nature, location and timing of each disaster. It has been estimated that between 2% and 5% of the injured will suffer from crush syndrome as reported for the Tangshan earthquake (242 769 dead and 164 851 injured). 1 After the collapse of a multi-storey building, 80% of its occupants will be killed instantly and 20% may be extricated alive if this is achieved within 24 hours. 2 However, approximately 40% of the survivors will suffer from the crush syndrome. Early death of extricated survivors is caused by shock and/or hyperkalaemia, whereas late death is caused by myoglobinuric acute renal failure and/or sepsis. During the last 30 years we have had the opportunity of studying mechanical musclecrush injury (MMCI) and its consequences, resulting from the entrapment of casualties under collapsed buildings. Our hospital has been the major trauma centre serving a chronic war zone catchment area, including the south Lebanon theatre, in which periodic flare-ups of war and terror have provided a recurrent source of crushing injuries. Furthermore, as consultants to the Rescue and Extrication Unit of the Israel Defence Forces, we have had the benefit of sharing this unit’s unique experiences. After an alert, this unit can be scrambled on to a Hercules transport aircraft in less than 24 hours and has succeeded in reaching several overseas earthquake disaster areas in sufficient time to undertake useful work. Orthopaedic surgeons throughout the world are frequently involved in the treatment of such casualties and yet may be unfamiliar with the accumulated world experience of the results of the treatment of MMCI. The purpose of this review is to summarise critically our own experience and that gleaned from the international literature.