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Compartment syndrome is a common complication of crush injury. Compartment syndrome of the thigh and pelvic region is a serious but rare condition prompting surgical emergency. Delayed compartment release leads to significant morbidity and mortality. We reported a case of severe crush injury of lower extremity who survived from a strong medical support in 285 days-hospital stay.
Case
This 32-year-old male survived from a 6.4-magnitude earthquake in Tainan, Taiwan. His lower extremity was crushed under a collapsed 17-storey building for 12 hours before rescue. He was sent to emergency department with severe right pelvis crushing injury and open fracture of right lower leg. Due to hemorrhagic shock and rhabdomyolysis, emergent right above-knee amputation with left leg fasciotomy was performed.
His unstable hemodynamics was supported with extra-corporeal membrane oxygenation (ECMO) after surgery. Subsequent fasciotomy of both thighs and further left above-knee amputation were performed for persisted compartment syndrome with rhabdomyolysis on the next day after injury. Due to progressive muscle necrosis with uncontrolled hyperkalemia (K+: 9.0 mmol/L), bilateral transfemoral disarticulation 3 days later.
Trans-arterial embolization of right iliac vessels was performed to control stump bleeding. More than 20 times of debridement were done for persistent muscle necrosis of the bilateral stump wounds. The wounds were healed eventually with vacuum assisted closure and skin graft. During 10 months of hospitalization and aggressive rehabilitation program, he was discharged under favorable condition.
Conclusion
Crush injury is one of common cause of death after earthquakes. Immediate fasciotomy is required for the cases of compartment syndrome. Despite emergent pressure release, urgent limb amputation should be considered in patients with progressive muscle necrosis and uncontrolled hyperkalemia.