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Earthquakes are unpredictable natural disasters causing massive injuries. We aim to review the surgical management of earthquake musculoskeletal injuries and the critical care of crush syndrome. We searched the English literature in PubMed without time restriction to select relevant papers. Retrieved articles were critically appraised and summarized. Open wounds should be cleaned, debrided, receive antibiotics, receive tetanus toxoid unless vaccinated in the last 5 years, and re-debrided as needed. The lower limb affected 48.5% (21.9%-81.4%) of body regions/patients. Fractures occurred in 31.1% (11.3%-78%) of body regions/patients. The most common surgery was open reduction and internal fixation done in 21% (0%-76.6%), followed by plaster of Paris in 18.2% (2.3%-48.8%), and external fixation in 6.6% (1%-13%) of operations/patients. Open fractures should be treated with external fixation. Internal fixation should not be done until the wound becomes clean and the fractured bones are properly covered with skin, skin graft, or flap. Fasciotomies were done in 15% (2.8%-27.2%), while amputations were done in 3.7% (0.4%-11.5%) of body regions/ patients. Principles of treating crush syndrome include: (1) administering proper intravenous fluids to maintain adequate urine output, (2) monitoring and managing hyperkalemia, and (3) considering renal replacement therapy in case of volume overload, severe hyperkalemia, severe acidemia, or severe uremia. Low-quality studies addressed indications for fasciotomy, amputation, and hyperbaric oxygen therapy. Prospective data collection on future medical management of earthquake injuries should be part of future disaster preparedness. We hope that this review will carry the essential knowledge needed for properly managing earthquake musculoskeletal injuries and crush syndrome in hospitalized patients. [ABSTRACT FROM AUTHOR]

Acute renal cortical necrosis (ACN) is a potentially fatal renal condition. Our objective is to report a case of ACN in a young man who had developed premature atherosclerotic vascular disease and required intermittent hemodialysis support. His renal biopsy showed diffuse cortical necrosis. Subsequently, 2 weeks after the renal insult, he developed a cardioembolic stroke and was anticoagulated with low-molecular-weight heparin. Thrombophilia screen revealed elevated serum homocystein and he was treated with folate supplement and vitamin B12 injection. With these treatments, he had partial renal recovery and became dialysis independent. In conclusion, this is a rare case of ACN, which may have occurred as a complication of hyperhomocysteinemia. [ABSTRACT FROM AUTHOR]

It is often difficult to differentiate acute renal failure (ARF) from chronic renal failure (CRF) when the patient presents with advanced uremia for the first time. Assessments of kidney size, history of nocturia, and pallor are used as indirect indicators of CRF. Some investigators have proposed an estimation of finger nail creatinine concentrations to differentiate between ARF and CRF, as patients with CRF have higher nail creatinine concentrations. Measurement of creatinine in the nail can be performed easily in a biochemistry laboratory. The nail clippings are cleaned, dried, pulverized and creatinine extracted from the powdered nail to be assessed biochemically. By standardizing the methods, the biochemistry laboratory can provide the results within 48 hours. In this study, we analyzed the nail clippings of 49 normal subjects, 50 cases of known acute kidney injury (AKI), and 50 cases of known CRF on follow-up at the Nephrology Clinic, Medical College, Trivandrum between December 1999 to November 2000. Forty-nine normal individuals were selected from healthy bystanders of respective patients. On study, it was revealed that patients with ARF had a mean fingernail creatinine level of 30.9 mg/100 g of nail as against 30.1 mg/100 g of nail in normal controls. There was no difference between the controls and ARF patients. Patients with known CRF had a mean fingernail creatinine level of 69.2 mg/100 g. There was a significant increase in the level of nail creatinine in patients with known CRF versus ARF patients and normal controls. The measurement of nail creatinine is useful, easy and can be standardized and performed in a biochemistry laboratory. This simple investigation can help in solving the question of ARF versus CRF in a given case. From this study, it is concluded that the result of creatinine concentrations of nail clippings can indicate chronicity of renal failure. [ABSTRACT FROM AUTHOR]