The effects of timing on fasciotomy outcomes in compartment syndrome - experience from crush-induced trauma following 2023 Turkey earthquakes

Abstract

Purpose: This study was planned to evaluate limb survival and clinical outcomes of fasciotomies done before and after 24-48 h due to compartment syndrome in the extremities caused by crush injuries after the earthquakes in Turkey on February 6-7, 2023.

Methods: We retrospectively analyzed 129 extremities of 84 patients that underwent fasciotomy after the 2023 Turkey earthquakes in this single center study. Demographical data of patients, affected limb, time to fasciotomy, limb survival, number of debridements, necrotic muscle debridement, whether graft-flap was needed, and the need for hemodialysis were analyzed. Extremities were grouped according to timing of fasciotomy (24-48 h) and subgroups were defined in terms of affected limb (upper/lower).

Result: 43 females (51.2%) and 41 males (48.8%) were included in the study. Mean age of patients was 34.5 ± 12.8 years. There were 39 upper, 90 lower extremities totaling 129. Amputations were performed in 25 (19.4%) extremities of 20 (23.8%) patients of which 5 were upper (5 transhumeral) and 20 were lower (3 hip disarticulation, 7 transfemoral, 10 transtibial). There was no need for amputation in patients fasciotomised within 24 h. Amputation was performed in 9 (11.5%) of 78 extremities fasciotomized between 24 and 48 h and in 16 (31.4%) of 51 extremities fasciotomized after 48 h (p = 0.005). Amputation rates were significantly higher in lower extremities after 48 h (p = 0.002) in contrast to upper extremities (p = 0.661). The median number of debridements in all extremities was 2 [1-4]. Muscle compartment excision was required in 27 extremities (%26). Of the remaining 34 upper extremities, 17 (50.0%) were closed with graft/flap application and of the remaining 70 lower extremities, 25 (35.7%) were closed with graft/flap application. 19 patients (22.6%) received hemodialysis, with significantly higher rate with late fasciotomies (p < 0.001 and 0.004 for 24 h and 48 h respectively).

Conclusion: Fasciotomies earlier than 24 h prevented amputation and rate of muscle compartment excision was higher in fasciotomies done after 24 h especially for lower extremities. Upper extremity fasciotomy timing early or late did not change the outcomes.

Keywords: Crush-induced compartment syndrome; Earthquake; Fasciotomy timing; Lower extremity fasciotomy; Upper extremity fasciotomy.