Skip to main content

Advertisement

SpringerLink
Log in

Preventing extremity amputations after earthquakes: a quantitative analysis of fasciotomy and extrication time

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to evaluate the impact of prolonged extrication time and the time to fasciotomy applications on amputation requirement by giving quantitative and cutoff values.

Methods

In this single-center study, the clinical records of patients with musculoskeletal injuries due to the 6 February Kahramanmaraş earthquake in Turkey were retrospectively reviewed. All patients who underwent fasciotomy or amputation regardless of age and gender were included in the study. 163 extremities of 140 patients who met the inclusion criteria were evaluated. Demographic data of the patients, such as age and gender, were recorded in this study. The primary outcome of this study was the correlation of the time between injury and fasciotomy applications with the amputation requirement. At the same time, the effect of prolonged extrication time of earthquake victims on amputation requirement.

Results

The mean age was 29.01 ± 15.55 of earthquake victims included in the current study and the gender distribution of the patients is almost equal. 87 amputations of 65 patients were performed and transtibial amputation was the most common type (41.3%). The mean fasciotomy time was 38.78 ± 23.64 h. Delayed fasciotomies performed after 45.5 h increase 28.48 times the amputation requirement. The mean extrication time in the current study was 36.49 h. The patients with extrication time longer than 23 h was associated with an 8.8 times higher risk of amputation.

Conclusions

Authors believe that knowledge of the relationship between earthquake survivors’ prognosis and time of extrication, as well as the impact of fasciotomy timing on extremity loss, is essential for a more successful treatment management in future disasters.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Data will always be shared by the corresponding author when requested.

References

  1. Konda SR, Kester BS, Fisher N, Behery OA, Crespo AM, Egol KA. Acute Compartment Syndrome of the Leg. J Orthop Trauma. 2017;31:S17–8.

    Article  PubMed  Google Scholar 

  2. Zhang D, Tarabochia M, Janssen SJ, Ring D, Chen N. Acute compartment syndrome in patients undergoing fasciotomy of the forearm and the leg. Int Orthop. 2019;43:1465–72.

    Article  PubMed  Google Scholar 

  3. Whitesides TE, Heckman MM. Acute compartment syndrome: update on diagnosis and treatment. J Am Acad Orthop Surg. 1996;4:209–18.

    Article  CAS  PubMed  Google Scholar 

  4. Rademacher E, Miller PE, Jordan E, May CJ, Glotzbecker MP, Bae DS, et al. Management of fasciotomy incisions after acute compartment syndrome: is delayed primary closure more feasible in children compared with adults? J Pediatr Orthop. 2020;40:e300–5.

    Article  PubMed  Google Scholar 

  5. Rorabeck C. The treatment of compartment syndromes of the leg. J Bone Jt Surg Br. 1984;66-B:93–7.

    Article  Google Scholar 

  6. Mubarak S, Carroll N. Volkmann’s contracture in children: aetiology and prevention. J Bone Joint Surg Br. 1979;61-B:285–93.

    Article  CAS  PubMed  Google Scholar 

  7. Farber A, Tan T-W, Hamburg NM, Kalish JA, Joglar F, Onigman T, et al. Early fasciotomy in patients with extremity vascular injury is associated with decreased risk of adverse limb outcomes: a review of the National Trauma Data Bank. Injury. 2012;43:1486–91.

    Article  PubMed  Google Scholar 

  8. Reis ND, Better OS. Mechanical muscle-crush injury and acute muscle-crush compartment syndrome. J Bone Jt Surg Br. 2005;87-B:450–3.

    Article  Google Scholar 

  9. Flynn JM, Bashyal RK, Yeger-McKeever M, Garner MR, Launay F, Sponseller PD. Acute traumatic compartment syndrome of the leg in children: diagnosis and outcome. J Bone Jnt Surg Am Vol. 2011;93:937–41.

    Article  Google Scholar 

  10. Weaver MJ, Owen TM, Morgan JH, Harris MB. Delayed primary closure of fasciotomy incisions in the lower leg. J Orthop Trauma. 2015;29:308–11.

    Article  PubMed  Google Scholar 

  11. Olson SA, Glasgow RR. Acute compartment syndrome in lower extremity musculoskeletal trauma. J Am Acad Orthop Surg. 2005;13:436–44.

    Article  PubMed  Google Scholar 

  12. Gerdin M, Wladis A, von Schreeb J. Surgical management of closed crush injury-induced compartment syndrome after earthquakes in resource-scarce settings. J Trauma Acute Care Surg. 2012;73:758–64.

    Article  PubMed  Google Scholar 

  13. Duman H. Fasciotomy in crush injury resulting from prolonged pressure in an earthquake in Turkey. Emerg Med J. 2003;20:251–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Williams AB, Luchette FA, Papaconstantinou HT, Lim E, Hurst JM, Johannigman JA, et al. The effect of early versus late fasciotomy in the management of extremity trauma. Surgery. 1997;122:861–6.

    Article  CAS  PubMed  Google Scholar 

  15. Mohammad Naghi T, Kambiz K, Shahriar JM, Afshin T, Kamrani Reza S, Behnam P, et al. Musculoskeletal injuries associated with earthquake. Injury. 2005;36:27–32.

    Article  Google Scholar 

  16. Sever MS. Clinical findings in the renal victims of a catastrophic disaster: the Marmara earthquake. Nephrol Dial Transpl. 2002;17:1942–9.

    Article  CAS  Google Scholar 

  17. Zhang L, Fu P, Wang L, Cai G, Zhang L, Chen D, et al. The clinical features and outcome of crush patients with acute kidney injury after the Wenchuan earthquake: Differences between elderly and younger adults. Injury. 2012;43:1470–5.

    Article  PubMed  Google Scholar 

  18. Kang P, Tang B, Liu Y, Liu X, Shen Y, Liu Z, et al. Profile and procedures for fractures among 1323 fracture patients from the 2010 Yushu earthquake, China. Am J Emerg Med. 2016;34:2132–9.

    Article  PubMed  Google Scholar 

  19. Sheridan GW, Matsen FA 3rd. Fasciotomy in the treatment of the acute compartment syndrome. J Bone Joint Surg Am. 1976;58(1):112–5.

    Article  CAS  PubMed  Google Scholar 

  20. Hope MJ, McQueen MM. Acute compartment syndrome in the absence of fracture. J Orthop Trauma. 2004;18:220–4.

    Article  CAS  PubMed  Google Scholar 

  21. Rothenberg KA, George EL, Trickey AW, Chandra V, Stern JR. Delayed fasciotomy is associated with higher risk of major amputation in patients with acute limb ischemia. Ann Vasc Surg. 2019;59:195–201.

    Article  PubMed  Google Scholar 

  22. Sever MS, Erek E, Vanholder R, Ozener C, Yavuz M, Kayacan SM, et al. Lessons learned from the Marmara disaster: time period under the rubble. Crit Care Med. 2002;30:2443–9.

    Article  PubMed  Google Scholar 

  23. Guner S, Guner SI, Isik Y, Gormeli G, Kalender AM, Turktas U, et al. Review of Van earthquakes form an orthopaedic perspective: a multicentre retrospective study. Int Orthop. 2013;37:119–24.

    Article  PubMed  Google Scholar 

Download references

Funding

The authors received no financial support for the research and/or authorship of this article.

Author information

Authors and Affiliations

  1. Department of Orthopedics and Traumatology Clinic, Ankara Bilkent City Hospital, Cankaya, Ankara, Turkey

    Olgun Bingol, Taner Karlidag, Omer Halit Keskin, Enver Kilic, Baran Sarikaya & Guzelali Ozdemir

Authors
  1. Olgun Bingol
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Taner Karlidag
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Omer Halit Keskin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Enver Kilic
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Baran Sarikaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guzelali Ozdemir
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Olgun Bingol.

Ethics declarations

Conflict of interest

The authors declared no conflict of interest with respect to the authorship and/or publication of this article.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bingol, O., Karlidag, T., Keskin, O.H. et al. Preventing extremity amputations after earthquakes: a quantitative analysis of fasciotomy and extrication time. Eur J Trauma Emerg Surg 49, 2515–2520 (2023). https://doi.org/10.1007/s00068-023-02325-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-023-02325-6

Keywords

Search

Navigation