EARTHQUAKE KNOWLEDGE UPDATE

EARTHQUAKE KNOWLEDGE UPDATEkapak

SURGICAL PREPARATION AND TIMIN

Hüseyin Utku Özdeş1 Emre Ergen2

1İnönü University, Faculty of Medicine, Turgut Özal Medical Center, Department of Orthopedics and Traumatology, Malatya, Türkiye
2İnönü University, Faculty of Medicine, Turgut Özal Medical Center, Department of Orthopedics and Traumatology, Malatya, Türkiye

Özdeş HU, Ergen E. Surgical Preparation and Timing. In: Kalenderer Ö, Servet E, editors. Earthquake Knowledge Update. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.35-44.

ABSTRACT

Earthquakes are unpredictable natural disasters that cause a significant number of injuries and deaths, depending on their intensity and the affected area. The most important finding observed after earthquakes, reflected in the healthcare system, is the struggle with numerous injuries of all kinds. Although there are differences in injury mechanisms, the most common cause is crush injuries resulting from being trapped under debris or being compressed under weight. The prevalence of extremity injuries creates a significant workload for orthopedic surgeons after earthquakes. While long bone fractures in the lower extremities and pelvic fractures are common, non-extremity organ-system injuries are also seen in earthquake victims, and they are generally multiple trauma patients. Additionally, two separate clinical conditions, crush syndrome and compartment syndrome, which are not exclusive to earthquakes, are also quite common and difficult to manage. Timely intervention for orthopedic injuries will reduce disabilities and deaths. However, timing is affected by many factors, and numerous challenges are observed after earthquakes. After highly destructive earthquakes, ongoing aftershocks, infrastructure issues such as transportation, water, and electricity in the region, the shortage of healthcare personnel providing services in the area, their status as earthquake victims, and sudden surges in hospitals far from regional hospitals are among these challenges. Therefore, preparations should be made before, not after, earthquakes. In a damage-free regional hospital where optimal conditions are provided, orthopedic emergencies should primarily be evaluated and surgical interventions should be applied. These include traumatic limb amputations, hemorrhagic unstable fractures, contaminated open injuries with or without fractures, acute compartment syndrome, and necrotizing crush syndrome without circulation. Injuries requiring reconstructive surgery, including closed fractures, should not be prioritized for surgery in regional hospitals or high patient volume aid hospitals after an initial intervention such as casting-splinting in the early period of earthquakes; triage should be applied. The most important factor affecting the success of fasciotomies performed due to acute compartment syndrome is their early application. The rate of secondary amputations decreases and the mortality rate significantly reduces after fasciotomies performed within the first 6 hours. In crush syndrome, where systemic findings appear, late fasciotomies lead to increased infection and mortality rates. Patients with crush syndrome should be closely monitored, and the decision for amputation should be made based on the patient’s physical examination findings and laboratory values. Amputation of a cyanotic, necrotic limb without peripheral pulses leads to limb loss but can be life-saving by reducing metabolic load.

Keywords: Earthquakes; Extremities; Crush syndrome; Compartment syndrome; Traumatic amputation

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