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Purposes: Amputation is a serious complication in patients with acute compartment syndrome (ACS). However, it risk factors are still poorly understood. Our study aims to investigate the risk factors of amputation in patients with ACS. Methods: We reviewed the data on ACS patients with tibial fractures from January 2010 to November 2022. Patients with amputation was grouped into the amputation group (AG) and those without amputation was grouped into non-amputation group (NG). We used univariate analysis, logistic regression analysis and nomogram prediction model to analyze the predictors of amputation. Results: The rate of amputation was 8.8% (12 of 136) in our study. Crush injury (p = 0.047), heavy object injury (p = 0.045), the presence of blisters (p<0.0001), the number of debridements (p = 0.022), muscle necrosis (p = 0.004), deep venous thrombosis (DVT, p<0.0001), the level of osmotic pressure (p = 0.003) after fasciotomy were found to be associated with amputation in ACS patients by univariate analysis. Logistic regression analysis showed that crush injury [p = 0.036, OR = 16.403, 95% CI (1.198, 224.609)], heavy object injury [p = 0.010, OR = 50.751, 95% CI (2.577, 999.490)], muscle necrosis [p = 0.017, OR = 17.272, 95% CI (1.666, 179.102)], and DVT [p = 0.009, OR = 22.344, 95% CI (2.146, 232.589)] were risk factors of amputation. Then, we constructed a nomogram prediction model with 0.9066 in AUC of the prediction model with good consistency in the correction curve and good clinical practicality by decision curve analysis. Conclusions: We identified crush injury, heavy object injury, muscle necrosis, and DVT as independent risk factors for amputation in ACS patients. Our nomogram prediction model can availably predict amputation in ACS patients. Additionally, we found that the timing of fasciotomy is not associated with amputation in ACS patients. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

BACKGROUND: Ebselen is a neuroprotective drug that protects cellular components from oxidative damage by modulating enzymatic cofactors, metalloproteins, gene expression, antioxidant-anti-inflammatory effects, and immunological systems. Our goal was to compare the efficacy of Ebselen and methylprednisolone on rat facial nerve crush injury. METHODS: Thirty healthy male Wistar rats (mean weight of 245 g) were used in this study. The rats were randomly divided into four groups: Group 1 (ebselen group), Group 2 (methylprednisolone group), Group 3 (control group), and Group 4 (sham group (the right side of the control group). Except for the sham group, all groups had their left facial nerve crushed. Three weeks after surgery, prospective functional, histologic, and electrophysiologic recovery was reported. RESULTS: The ebselen group and methylprednisolone group had similar and more significant recovery at Nerve Excitability Thresholds (NET) at the end of three weeks. These groups also showed similar features in terms of histopathological parameters such as axonal degeneration, vascular congestion, axon diameter, and myelin thickness. Except for the macrovacuolization parameter, both showed statistically better results than the control group. Although there was an earlier improvement in the whiskers and blink tests in the ebselen group compared to the methylprednisolone and control groups, complete recovery was observed in all groups on the 21st day. CONCLUSION: Ebselen was found to be similarly effective to methylprednisolone in nerve regeneration in a rat model of experimental facial nerve crush. Considering that methylprednisolone has serious systemic side effects, ebselen may be a good alternative. [ABSTRACT FROM AUTHOR]

Extremity trauma, including ischemia (e.g., prolonged tourniquet application or crush), is common among battlefield injuries. Injured muscle releases toxins leading to rhabdomyolysis and, potentially, acute kidney injury (AKI). The goal of this study was to characterize sequelae of ischemic extremity injury over 72 h, focusing on time courses of rhabdomyolysis and AKI. Male Sprague Dawley rats were placed into two groups. Ischemic injury was produced in anesthetized rats using bilateral tourniquets (TK; n = 10) for 5 h; control (CON; n = 9) rats were treated identically without TK application. Indicators of rhabdomyolysis and renal function were measured in conscious rats 1 day preinjury (baseline, BL) and then at 1.5, 24, 48, and 72 h post-TK release. Prolonged TK application produced necrosis in both muscle and bone marrow but not in kidney. The wet/dry weights indicated edema in injured limbs at 72 h (4.1 (0.5) (TK) vs. 2.9 (0.1) (CON); p < 0.001). TK rats exhibited a 100-fold increase in creatine kinase activity compared to CON at 1.5 h (20,040 (7265) U/L vs. 195 (86) U/L (mean (SD); p < 0.0001). TK decreased the mean glomerular filtration rate (GFR; p < 0.001) at 1.5 h, but these values recovered by 24 h in concert with elevated urinary flow and alkalinization. Prolonged ischemic extremity injury therefore produced severe rhabdomyolysis without irreversible renal damage. [ABSTRACT FROM AUTHOR]

Abstract Purposes Amputation is a serious complication in patients with acute compartment syndrome (ACS). However, it risk factors are still poorly understood. Our study aims to investigate the risk factors of amputation in patients with ACS. Methods We reviewed the data on ACS patients with tibial fractures from January 2010 to November 2022. Patients with amputation was grouped into the amputation group (AG) and those without amputation was grouped into non-amputation group (NG). We used univariate analysis, logistic regression analysis and nomogram prediction model to analyze the predictors of amputation. Results The rate of amputation was 8.8% (12 of 136) in our study. Crush injury (p = 0.047), heavy object injury (p = 0.045), the presence of blisters (p

Aim: This study aims to examine earthquake-related upper extremity orthopedic injuries, and in our clinic, the plastic, reconstructive, and esthetic treatment methods applied to them after the two biggest earthquakes in Kahramanmaraş, Turkey. Materials and Methods: This is a descriptive cross-sectional study and was conducted with 38 earthquake victims who were treated at the plastic, reconstructive, and esthetic surgery unit of a medical school health and research hospital in the Southeast Anatolia region of Turkey. Patient data were obtained retrospectively from electronic medical records, and descriptive statistical methods, Chi-square test, and post hoc were used for data analysis. Results: Of the earthquake victims, 55% were between 18 and 35 years old, 68% were female, 63% underwent plastic, reconstructive, and esthetic surgery due to upper extremity injuries, 50% had skin grafting, and 15% had amputation. In addition, 18.4% of the earthquake victims underwent surgery 3 times, and 13% were operated on 7 times. Conclusion: Careful attention should be paid to the treatment of upper extremity injuries that occur during major earthquakes. Delayed or inadequate interventions can result in amputation, highlighting the importance of plastic, reconstructive, and esthetic surgeons in disaster response teams. If possible, conservative treatment should be preferred for fractures in disaster environments. Amputation should always be the last treatment option for crush injuries. In cases requiring surgery, time should not be wasted.

Aim: This study aims to examine earthquake-related upper extremity orthopedic injuries, and in our clinic, the plastic, reconstructive, and esthetic treatment methods applied to them after the two biggest earthquakes in Kahramanmaraş, Turkey. Materials and Methods: This is a descriptive cross-sectional study and was conducted with 38 earthquake victims who were treated at the plastic, reconstructive, and esthetic surgery unit of a medical school health and research hospital in the Southeast Anatolia region of Turkey. Patient data were obtained retrospectively from electronic medical records, and descriptive statistical methods, Chi-square test, and post hoc were used for data analysis. Results: Of the earthquake victims, 55% were between 18 and 35 years old, 68% were female, 63% underwent plastic, reconstructive, and esthetic surgery due to upper extremity injuries, 50% had skin grafting, and 15% had amputation. In addition, 18.4% of the earthquake victims underwent surgery 3 times, and 13% were operated on 7 times. Conclusion: Careful attention should be paid to the treatment of upper extremity injuries that occur during major earthquakes. Delayed or inadequate interventions can result in amputation, highlighting the importance of plastic, reconstructive, and esthetic surgeons in disaster response teams. If possible, conservative treatment should be preferred for fractures in disaster environments. Amputation should always be the last treatment option for crush injuries. In cases requiring surgery, time should not be wasted. [ABSTRACT FROM AUTHOR]

It is important to predict which patients may require renal replacement therapy (RRT) at the time of initial presentation after crush injuries. There is limited data in the literature examining the predictors of RRT. This study was conducted by evaluating 2232 patients who presented to our hospital following two major earthquakes of magnitudes 7.6 and 7.7 Mw that occurred in Kahramanmaras, Turkey, on February 6, 2023. A total of 314 patients who were hospitalized upon being rescued from the rubble and had a creatine kinase (CK) level above 1000 U/L were included in the final analysis. Factors predicting the need for RRT were investigated, and a dialysis score was developed for this prediction. Of the 314 patients included in the study, 95 (30.2 %) developed acute kidney injury (AKI). RRT was performed on 68 (21.6 %) patients. The optimal cut-off value of CK for the prediction of AKI was 23,000 U/L. Multivariate analysis revealed that factors predicting RRT were the number of traumatized sides (odds ratio [OR]: 2.2, 95 % confidence interval [CI]: 1.09–4.39, p = 0.026), albumin (OR:0.11, 95 % CI: 0.04–0.32, p < 0.001), and CK (OR: 1.00, 95 % CI 1.00–1.00, p < 0.001). A dialysis score was developed ranging from 0 to 7 based on the number of traumatized sides, albumin, and CK. The area under the curve (AUC) of the dialysis score in receiver operating characteristic analysis was 0.974. A dialysis score of 4 or higher had a sensitivity of 97.1 % and a specificity of 89.4 % for predicting the need for RRT. The dialysis score predicts the need for RRT quite well. The simplicity of use and high sensitivity and specificity of this score in earthquake-related crush injuries will greatly facilitate clinicians in patient triage and follow-up. [ABSTRACT FROM AUTHOR]

Hyperbaric oxygen therapy (HBOT) is utilized as an adjunctive treatment for human and veterinary patients with compromised tissues. Medical records from two veterinary hospitals with HBOT chambers were searched for small animal veterinary dentistry and oral surgery specialty patients. The HBOT records were combined with the medical records from the referring specialty veterinary dentistry and oral surgery services. Clinical indications for HBOT treatments associated with a positive outcome in this case series included resistant bacterial infections, electrical cord injury, bite wound injuries, osteomyelitis, crush/traumatic injuries including mandibular fractures, oral surgery performed at previously irradiated sites, and osteonecrosis, presumably radiation induced. Conditions within this case series that remained unchanged or were associated with partial improvement included preoperative treatment of stomatitis without steroid usage and delayed HBOT treatment for long-term endodontic health of laterally luxated immature permanent mandibular incisors. Eighty-eight percent of the HBOT sessions were tolerated well by the patients in this case series. The most common adverse event was mild anxiety. One patient required oral anxiolytic medications to complete the course of treatment. One patient experienced transient seizure activity and was able to complete that session as well as subsequent sessions at a lower chamber pressure. Future prospective studies are necessary to further evaluate and characterize the potential benefits of HBOT as well as to clarify optimal treatment protocols for specific conditions in veterinary dentistry and oral surgery. [ABSTRACT FROM AUTHOR]

Purpose: Digit-tip amputation caused by crush injury is a common emergency scenario, and the management is full of challenges. The objective of this study was to demonstrate the application of the supermicrosurgery technique in replantation procedures for complex digit-tip amputations resulting from crush injuries, while also assessing functional and aesthetic outcomes. Methods: We conducted a retrospective analysis of the data from 12 patients who underwent replantation of 15 digits in our department between July 2022 and June 2023. The outcomes of replantation, functional recovery (including return to work, cold tolerance, bone union, DASH score, VAS score, and two-point discrimination test), aesthetic results (including digit appearance, nail deformity, and pulp atrophy), and patient satisfaction were assessed. Results: The amputation of 7 digits occurred within Tamai zone I level, 8 digits within Tamai zone II level, while 4 digits occurred within Ishikawa zone I level, 3 digits within Ishikawa zone II level, 7 digits within Ishikawa zone III level, and 1 digit within Ishikawa zone IV level. The replanted digits all survived (100%) without any indications of arterial insufficiency or venous congestion. The follow-up procedures were conducted on all 12 patients, with an average duration of 9.6 months (range, 6 to 18 months). The fracture successfully underwent healing at 9.2 weeks (range, 8 to 13 weeks). The mean VAS score was 1.75 points (range 0 to 4 points), the mean two-point discrimination test result was 5.72 mm (range 4.0 to 7.0 mm), and the mean DASH score was 9.78 points (range 3.33 to 22.5 points). All patients demonstrated cold tolerance and successfully resumed their pre-injury occupational activities. The nail deformity was observed in one digit following replantation within Tamai zone I, and in three digits following replantation within Tamai zone II; moreover, eight digits exhibited varying degrees of pulp atrophy. All patients expressed satisfaction with both functional and aesthetic outcomes. Conclusion: The successful replantation of digit-tip amputation caused by crush injury can be achieved through the application of supermicrosurgery technique, resulting in improved functional and aesthetic outcomes. Digit-tip replantation is a favorable and meaningful procedure with high patient satisfaction. [ABSTRACT FROM AUTHOR]

Copyright of Anatolian Journal of General Medical Research is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Case: An overall healthy 48-year-old man suffered a left foot mangled crush injury resulting in a post-transmetatarsal amputation and subsequently developing a painful neuroma on the plantar surface of the foot. To avoid the zone of injury, targeted muscle reinnervation was used to treat the neuroma by coapting the tibial nerve to the motor point of the flexor hallucis longus (FHL) muscle. At 1-year follow-up, the patient reported no pain at rest, returned to work, and could ambulate with an orthosis for 30 minutes. Conclusion: Rare tibial nerve coaptations to the FHL could serve as a treatment option for patients with neuromas in traumatic postmetatarsal amputation. [ABSTRACT FROM AUTHOR]

Objective: There is limited evidence for the early and rapid assessment of earthquake-related soft tissue injuries. This research examined parameters that can be utilized to identify the prognosis of patients with these injuries. Materials and Methods: This retrospective study was conducted at Erciyes University. Patients injured in the Kahramanmaraş-centered earthquake in Türkiye in 2023 were enrolled. The effect of injury types, trauma, and injury severity scores (TRISS), and specific laboratory values of the patients at the time of application on the success of soft tissue reconstruction was investigated. Results: A total of 61 patients were enrolled in the study. The median TRISS scores were 98.35 in Group 1, 88.20 in Group 2, and 57.35 in Group 3. The TRISS scores exhibited statistically significant differences between the groups. The TRISS score of Group 3 was found to be significantly lower than those of Groups 1 and 2 (p<0.001, p<0.011, respectively). Prolongation of the time spent under the wreckage and elevated TRISS scores were correlated with an increase in the number of injury debridements, a decrease in injury closure success, an increase in the frequency of Acinetobacter baumanii reproduction, an increase in the need for amputation, an increase in mortality, and hospitalization costs (p<0.05). Conclusion: In the early and rapid assessment of earthquake-related soft tissue injuries, the time spent under the wreckage and the TRISS score were crucial parameters in determining the prognosis. The parameters mentioned above may guide the management of patients with earthquake-related soft tissue injuries. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the effect of dietary sesame oil and ginger oil supplements on the dorsal root ganglia following a sciatic nerve crush model in male Wistar albino rats. Crush injury models have been done by means of graded forceps (50 Newton). The animals were given a daily sesame oil (4 ml/kg/day) and ginger oil (400 mg/kg/day) via oral gavage for a period of 28 days. Dorsal root ganglia from the L5 levels were harvested. Processing of tissues was done for electron microscopy and light microscopy. Immunohistochemical staining with active caspase-3 antibody and qualitative ultrastructural analyses of tissues were made by a light and a transmission electron microscope, respectively. The results showed that crush injury leads to remarkable ultrastructural changes in sensory neurons, such as swollen mitochondria, disruption of cristae structure, glial cell proliferation and, consequently, phagocytosis of the damaged neuron. These ultrastructural changes were less evident in the treated groups, and both natural compounds reduced the expression of activated caspase-3, which may also affect ultrastructural changes. The application of the natural products sesame oil and ginger oil may represent a supportive approach to the protection of sensory neurons against the destructive effects of peripheral nerve crush injury. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Crush injuries and open fractures are often accompanied by extensive tissue loss, rendering clinical and surgical management quite challenging, particularly in the upper extremities. The primary goal in these cases is to obtain a functional and cosmetically acceptable limb. However, the management of complex crush injuries (involving extensive tissue loss and open fractures) is associated with a variety of complications, ranging from infection to amputation. In this study, we aimed to analyze the clinical outcomes of reconstruction for managing complex upper extremity crush injuries. PATIENTS AND METHODS: We reviewed the clinical and surgical data of patients with complex upper extremity crush injuries who were treated at five Level III trauma centers between July 2012 and December 2022. Patients with an injury that could not be replanted at the time of trauma, those who succumbed to the injuries before reconstruction, and patients with a postoperative follow-up time of < 1-year, missing data, or lost to follow-up were excluded. Data regarding demographic characteristics, clinical examination, radiological images, mechanism of injury, orthopedic or non-orthopedic injuries, comorbidities, tissue loss size, surgical procedures, number of debridement and first debridement time, complications, number of days of hospitalization and, if any, intensive care unit stay, were recorded. RESULTS: Twenty-one patients were included in the study (mean age = 37.4 ± 7.25; range = 16- 62 years; 17 males, 4 females). Road traffic accidents were the most frequently documented cause of injury. The mean time to the first reconstruction was 4.2 ± 1.2 days. Tissue defect sizes ranged from 6 × 4 cm to 18 × 12 cm. Anterolateral thigh flaps, latissimus dorsi flaps, radial forearm, and lateral arm flaps, with sizes ranging from 3 × 6 cm to 18 × 26 cm, were used in the patients. CONCLUSIONS: Simple reconstruction techniques, such as skin grafts or island flaps, can provide satisfactory results in terms of both appearance and function in upper extremity crush injuries with significant bone exposure and large soft tissue defects. [ABSTRACT FROM AUTHOR]

Abstract Acute compartment syndrome (ACS) is a severe orthopedic issue that, if left untreated, can result in lasting nerve and muscle damage or even necessitate amputation. The association between admission laboratory blood test indicators and the occurrence of ACS in patients with tibial diaphysis fractures is currently a subject of debate. The objective of this research was to identify the contributing factors for ACS in individuals suffering from tibial diaphysis fractures. In this retrospective study, we collected data on a total of 705 individuals from our hospital, comprising 86 ACS patients and 619 non-ACS patients with tibial diaphysis fractures. These participants were categorized into two distinct groups: the ACS group and the non-ACS group. Despite the inherent limitations associated with retrospective analyses, such as potential biases in data collection and interpretation, we conducted a comprehensive analysis of demographics, comorbidities, and admission lab results. Our analytical approach included univariate analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis techniques, aiming to mitigate these limitations and provide robust findings. The statistical analysis revealed several predictors of ACS, including gender (p = 0.011, OR = 3.200), crush injuries (p = 0.004, OR = 4.622), lactic dehydrogenase (LDH) levels (p

Peripheral nerve injuries are extremely severe and may lead to permanent disability, despite the regenerative capacity of the peripheral nervous system (PNS). To date, there is no established pharmacological therapy capable of predicting functional recovery and alleviation of trauma-related symptoms such as neuropathic pain, inflammation and weakness, which are the main targets for current therapies. In this work we provide new evidence for a therapeutic use of valproic acid (VPA) upon ischiatic nerve injury. Ischiatic nerve-injured mice treated with VPA after lesion, displayed an improvement in pain and motor function associated with an increase in the number of myelinated nerve fibers, and exhibited a more organized microenvironment during regeneration. In addition, VPA treatment also promoted an immunomodulatory capacity, leading to a significant enhancement of neutrophils in the peritoneal cavity, suggesting its role on the sensory and motor recovery after ischiatic nerve injury. This highlights the physiological role of VPA during ischiatic nerve regeneration and contributes to the characterization of innovative pharmacological epigenetic therapy capable of accelerating peripheral nerve regeneration with critical impacts on the clinical practice.

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Acute compartment syndrome (ACS) is a severe orthopedic issue that, if left untreated, can result in lasting nerve and muscle damage or even necessitate amputation. The association between admission laboratory blood test indicators and the occurrence of ACS in patients with tibial diaphysis fractures is currently a subject of debate. The objective of this research was to identify the contributing factors for ACS in individuals suffering from tibial diaphysis fractures. In this retrospective study, we collected data on a total of 705 individuals from our hospital, comprising 86 ACS patients and 619 non-ACS patients with tibial diaphysis fractures. These participants were categorized into two distinct groups: the ACS group and the non-ACS group. Despite the inherent limitations associated with retrospective analyses, such as potential biases in data collection and interpretation, we conducted a comprehensive analysis of demographics, comorbidities, and admission lab results. Our analytical approach included univariate analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis techniques, aiming to mitigate these limitations and provide robust findings. The statistical analysis revealed several predictors of ACS, including gender (p = 0.011, OR = 3.200), crush injuries (p = 0.004, OR = 4.622), lactic dehydrogenase (LDH) levels (p < 0.001, OR = 1.003), and white blood cell (WBC) count (p < 0.001, OR = 1.246). Interestingly, the study also found that certain factors, such as falls on the same level (p = 0.007, OR = 0.334) and cholinesterase (CHE) levels (p < 0.001, OR = 0.721), seem to provide a degree of protection against ACS. In order to better predict ACS, the ROC curve analysis was employed, which determined threshold values for LDH and WBC. The established cut-off points were set at 266.26 U/L for LDH and 11.7 × 109 cells per liter for WBC, respectively. Our research has successfully pinpointed gender, crush injuries, LDH levels, and white blood cell (WBC) count as crucial risk factors for the development of ACS in patients experiencing tibial diaphysis fractures. Furthermore, by establishing the cut-off values for LDH and WBC, we have facilitated a more personalized assessment of ACS risk, enabling clinical doctors to implement targeted early interventions and optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: This case series aims to provide a comprehensive description of the utilization of doppler ultrasonography (USG) and computerized tomography angiography (CTA) in evaluating patients with earthquake-induced crush injuries in the emergency department (ED). Methods: This retrospective case series was conducted on 11 patients who presented with crush injuries following a seismic event. These patients underwent initial assessment using doppler USG, with CTA performed when deemed necessary. Clinical outcomes and diagnostic findings were systematically reviewed. Results: A cohort of 11 earthquake-related crush injury patients (six females, five males; age 3-59 years), predominantly with lower extremity injuries, with entrapped durations that ranged from 12 to 128 hours. Transport centers received patients from both affected regions and nearby provinces. Initial X-rays identified fractures in two cases. Doppler USG and subsequent CTA were employed for vascular evaluation, with CTA confirming doppler USG findings. Of the 11 patients, five exhibited abnormal doppler USG findings. Four patients required dialysis and four underwent amputation surgery. Fasciotomy and debridement procedures were performed in five and seven patients, respectively. Three patients received hyperbaric oxygen therapy (HBOT). Conclusion: Doppler USG emerged as a dependable tool for assessing vascular injuries in earthquake-related crush injuries, offering an effective alternative to CTA without the associated contrast agent risks. These findings underscore the need for further research to establish definitive imaging guidelines in these challenging clinical scenarios. [ABSTRACT FROM AUTHOR]

Evoked motor responses (distal muscle responses) to a specific nerve stimulation are considered an endpoint. Often in crush injuries of the upper limb below the level of the elbow, the distal muscle responses are irrelevant. We report 14 cases of crush injuries of the upper limb that underwent an amputation below the level of the elbow. A parasagittal ultrasound-guided infraclavicular block without neurostimulation was administered in all patients. A reliable local anesthetic (LA) spread either in the perineural or perivascular area is considered adequate. Adequate intraoperative anesthesia and postoperative analgesia were achieved with the deposition of LA beneath the axillary artery.

Background/Aims:Due to the prioritization of limb and life-saving efforts by medical teams, peripheral nerve injuries (PNIs) resulting from earthquakes are frequently overlooked or receive delayed treatment. Thus, we examined earthquake-related PNIs in terms of their descriptive characteristics and injury patterns Methods: The study was conducted retrospectively in a tertiary hospital after Kahramanmaraş Earthquakes. The study included victims under rubble admitted to the hospital and diagnosed with PNI according to their medical records between 06 February and 28 February 2023. Results: The study included 70 patients and a total of 98 limbs with PNIs, with a mean patient age of 22.31±14.91 years. 77.6% (n=76) of PNIs involved the lower limb (68 peroneal and 8 sciatic nerves) and 22.4% (n=22) of PNIs involved the upper limbs (14 radial nerves, 5 ulnar nerves, 2 median nerves, 1 brachial plexus). It was found that 45.9% of PNIs (n=45) occurred in the right and 54.1% (n=53) in the left extremities. The median time under the rubble of the patients was 15 hours (IQR 8.75 - 32 hours). Fasciotomy was treated in 54.1% (n=43) of the extremities with PNI. Fasciotomies were most commonly performed on the cruris (42.9%), foot (26.5%), and thigh (16.3%). Conclusion: This study found that PNIs occurred most frequently in the lower limbs, compared with the upper limbs, among earthquake victims with CLIs. Lower limb PNIs mainly occurred in the peroneal nerve, while upper limb PNIs mainly occurred in the radial nerve.

Abstract Background The purpose of this retrospective, single-institutional study was to report the clinical features and outcomes of orthopaedic injuries after the Kahramanmaraş earthquake. Methods An institutional database review was conducted to evaluate the results of patients who applied to our hospital’s emergency department after the Kahramanmaraş earthquake. Trauma patients referred to orthopaedics and traumatology were identified. Patient records were checked for injury type, fracture site, treatment type (conservative or surgical), surgical technique, and outcome. Diagnosis with crush syndrome and the need for haemodialysis were also noted. Bedside fasciotomy was undertaken based on the urgency of the patient’s condition, number of patients and the availability of the operating theatre. A team consisting of a trauma surgeon, a plastic surgeon, a board-certified physician in infectious disease, a reanimation specialist, a general surgeon and a nephrologist followed up with the patients. Results Within the first 7 days following the earthquake, 265 patients were admitted to the emergency department, and 112 (42.2%) of them were referred to orthopaedics and traumatology. There were 32 (28.5%) patients diagnosed with acute compartment syndrome. Fasciotomy was performed on 43 extremities of 32 patients. Of these extremities, 5 (11.6%) were upper and 38 (88.4%) were lower extremities.The surgeries of 16 (50%) of the patients who underwent fasciotomy were performed in the emergency department. There was no significant difference in terms of complications and outcomes between performing the fasciotomy at the bedside or in the operating theatre (p = 0.456). Conclusions Fasciotomy appears to be a crucial surgical procedure for the care of earthquake causalities. Fasciotomy can be safely performed as a bedside procedure based on the urgency of the patient’s condition as well as the availability of the operating theatre.

Extremity trauma, including ischemia (e.g., prolonged tourniquet application or crush), is common among battlefield injuries. Injured muscle releases toxins leading to rhabdomyolysis and, potentially, acute kidney injury (AKI). The goal of this study was to characterize sequelae of ischemic extremity injury over 72 h, focusing on time courses of rhabdomyolysis and AKI. Male Sprague Dawley rats were placed into two groups. Ischemic injury was produced in anesthetized rats using bilateral tourniquets (TK; n = 10) for 5 h; control (CON; n = 9) rats were treated identically without TK application. Indicators of rhabdomyolysis and renal function were measured in conscious rats 1 day preinjury (baseline, BL) and then at 1.5, 24, 48, and 72 h post-TK release. Prolonged TK application produced necrosis in both muscle and bone marrow but not in kidney. The wet/dry weights indicated edema in injured limbs at 72 h (4.1 (0.5) (TK) vs. 2.9 (0.1) (CON); p < 0.001). TK rats exhibited a 100-fold increase in creatine kinase activity compared to CON at 1.5 h (20,040 (7265) U/L vs. 195 (86) U/L (mean (SD); p < 0.0001). TK decreased the mean glomerular filtration rate (GFR; p < 0.001) at 1.5 h, but these values recovered by 24 h in concert with elevated urinary flow and alkalinization. Prolonged ischemic extremity injury therefore produced severe rhabdomyolysis without irreversible renal damage.

Hyperbaric oxygen therapy (HBOT) has been used as an adjuvant treatment for crush injury because it can improve tissue hypoxia and stimulate wound healing. However, the actual role of HBOT in crush hand injury is still unknown. This study is to assess the efficacy of HBOT for crush hand patients, as well as the impact of HBOT initiation timing. Between 2018 and 2021, 72 patients with crush hand injury were retrospectively reviewed. The patients were divided into the HBOT and control group, and each group had 36 patients. The average session of HBOT was 18.2 (5–32 sessions) per patient, and no patient had a complication related to the treatment. The two groups had similar demographics, but HBOT group had larger injured area (73.6 ± 51.0 vs. 48.2 ± 45.5 cm2, p = 0.03). To better control the confounding factors, we performed the subgroup analysis with cut‐off injured area of 50 cm2. In the patients with smaller injured area (≦50 cm2), the HBOT group had shorter wound healing time (29.9 ± 12.9 vs. 41.0 ± 18.9 days, p = 0.03). The early HBOT group (first session ≤72 h post‐operatively) had shorter hospital stay (8.1 ± 6.4 vs. 15.5 ± 11.4 days, p = 0.04), faster wound healing (28.7 ± 17.8 vs. 41.1 ± 18.1 days, p = 0.08) and less operations (1.54 ± 0.78 vs. 2.41 ± 1.62, p = 0.06) although the latter two didn't achieve statistical significance. HBOT is safe and effective in improving wound healing of hand crush injury. Early intervention of HBOT may be more beneficial. Future research is required to provide more evidence. [ABSTRACT FROM AUTHOR]

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Background/Aims: Due to the prioritization of limb and life-saving efforts by medical teams, peripheral nerve injuries (PNIs) resulting from earthquakes are frequently overlooked or receive delayed treatment. Thus, we examined earthquake-related PNIs in terms of their descriptive characteristics and injury patterns Methods: The study was conducted retrospectively in a tertiary hospital after Kahramanmaraş Earthquakes. The study included victims under rubble admitted to the hospital and diagnosed with PNI according to their medical records between 06 February and 28 February 2023. Results: The study included 70 patients and a total of 98 limbs with PNIs, with a mean patient age of 22.31±14.91 years. 77.6% (n=76) of PNIs involved the lower limb (68 peroneal and 8 sciatic nerves) and 22.4% (n=22) of PNIs involved the upper limbs (14 radial nerves, 5 ulnar nerves, 2 median nerves, 1 brachial plexus). It was found that 45.9% of PNIs (n=45) occurred in the right and 54.1% (n=53) in the left extremities. The average time patients spent under the rubble was 15 hours (IQR 8.75 - 32 hours). Fasciotomy was treated in 54.1% (n=43) of the extremities with PNI. Fasciotomies were most commonly performed on the cruris (42.9%), foot (26.5%), and thigh (16.3%). Conclusion: This study found that PNIs occurred most frequently in the lower limbs, compared with the upper limbs, among earthquake victims with CLIs. Lower limb PNIs mainly occurred in the peroneal nerve, while upper limb PNIs mainly occurred in the radial nerve. [ABSTRACT FROM AUTHOR]

Purpose: Limb amputation is one of the oldest medical operations, dating back over 2500 years to Hippocrates' time. In developing countries like India, most of the patients are young, and trauma is the primary cause of limb amputation. The objectives of this study were to investigate the factors that can predict the outcome of patients who underwent upper or lower limb amputations. Materials and methods: This was a retrospective analysis of the prospectively collected data of patients who underwent limb amputations from January 2015 to December 2019. Results: From January 2015 to December 2019, 547 patients underwent limb amputations. Males predominated (86%). Road traffic injuries (RTI) were the most common (323, 59%) mechanism of injury. Hemorrhagic shock was present in 125 (22.9%) patients. Above-knee amputation was the most common (33%) amputation procedure performed. The correlation of hemodynamic status at presentation with the outcome was statistically significant (p-0.001). Outcome measures like delayed presentation, hemorrhagic shock, Injury severity scores (ISS), and the new injury severity scores (NISS) were statistically significant (p-0.001) when compared to the outcome. There were 47 (8.6%) mortalities during the study period. Conclusion: Factors that affected the outcome were delayed presentation, hemorrhagic shock, higher ISS, NISS, MESS scores, surgical-site infection, and associated injuries. Overall mortality during the study was 8.6%. [ABSTRACT FROM AUTHOR]

This case report describes the intricate aspects of managing pediatric lower limb trauma. A 7-year-old patient had a severe compound fracture and significant soft tissue damage in the left lower limb, classified as Gustilo Grade IIIC. This necessitated the use of scoring systems such as the Mangled Extremity Severity Score and limb salvage index to assess the likelihood of limb preservation. Despite these high amputation risk indicators, a multidisciplinary approach has led to limb salvage surgery with internal fixation. Detailed postoperative monitoring revealed progressive recovery culminating in restored sensation, bone healing, and functional recovery. The discussion emphasizes the difficulties in deciding between limb salvage and amputation, stressing the importance of tailored care and cautious scoring system interpretation in pediatric cases. This conclusion advocates the prioritization of limb salvage in children owing to their unique healing capabilities while highlighting the need for further research to refine treatment protocols for pediatric lower limb trauma. [ABSTRACT FROM AUTHOR]

Kahramanmaraş was hit by two major earthquakes nine hours apart on February 6th, 2023, with magnitudes of 7.8 and 7.5 on the Richter scale, respectively. Ten other cities were also devastatingly affected by these earthquakes. More than 50 thousand people died in Turkey. The occurrence of two severe earthquakes on the same day in such a wide geographical area caused significant challenges. This disaster, with its devastating effects, focused attention on the significance of establishing a national and comprehensive emergency disaster plan prior to any disaster. Additionally, it highlighted the necessity of preparing a well-organized healthcare team capable of providing prompt and appropriate fluid replacement for pediatric patients in the early stages of a disaster. This is a crucial issue which must be addressed prior to major disasters. Another very important issue in this tragic disaster was the condition of chronically ill pediatric patients. Indeed, an emergency response is important not only for disaster victims, but also for those patients with chronic diseases in need of uninterrupted medical care. It is vital that individuals of all ages, as well as personnel from all sectors, receive the appropriate education, awareness, and knowledge on what actions to take, where to go, and where to gather in such situations.

Retrieval of four finger injury at proximal stump amputation with segmental injury along with soft tissue defect and impending compartment syndrome continues to be challenge for the surgeon. Immediate transplant considering temporary ectopic foster as a practical option in special case. We describe temporary ectopic finger implant for crush injury at Metacarpophalangeal (MCP level) with hand torsion along with forearm compartment was fostered to Dorsum of the foot. The torsion fingers was temporary fixed with mini external fixator for stabilization as salvage, ALT free flap was used to cover soft tissue defect of the hand. Replantation of survived figure was performed using the long pedicle to anatomical site without crushing the MCP joint to allow for later tendon transfer for finger. Satisfactory function regained with no foster site (foot) complication like pain or disability. The author validated ectopic foster for amputee as and procedure of choice for salvage of extremity under special circumstances.

Currently, despite decades of trial and error, peripheral nerve injury is an impenetrable clinical dilemma. Any proven effective pharmacologic agent leads to a decisive leap forward to the clinical management of neuropathies. This study investigated the effects of tacrolimus and erythropoietin on sciatic nerve regeneration. Twenty-three mice were randomly assigned to tacrolimus, erythropoietin, tacrolimus + erythropoietin, control, and sham groups following sciatic nerve crush via hemostatic forceps. Medications were administered for 28 consecutive days. The sham group received neither crush injury nor medication. Histopathologic, immunohistochemical, and walking track analyses were performed. In the erythropoietin group, axonal swelling was significantly reduced and the average axonal number significantly recovered up to 75% of normal nerve compared to other groups. Marked immunoreactivity to GFAP and S-100 protein was present in the tacrolimus group. Nevertheless, at least moderate GFAP and S-100 expressions were observed in all of the groups. Functional recovery was superior in the tacrolimus group after 14 days, although a complete return to near-normal function was achieved in all groups after 28 days, regardless of the medication used. Our data supported the neurotrophic effects of tacrolimus and erythropoietin; however, not enough data was gathered to confirm their synergistic effects. Whether these results are extensible to clinical scenarios requires further detailed investigations.

Evoked motor responses (distal muscle responses) to a specific nerve stimulation are considered an endpoint. Often in crush injuries of the upper limb below the level of the elbow, the distal muscle responses are irrelevant. We report 14 cases of crush injuries of the upper limb that underwent an amputation below the level of the elbow. A parasagittal ultrasound-guided infraclavicular block without neurostimulation was administered in all patients. A reliable local anesthetic (LA) spread either in the perineural or perivascular area is considered adequate. Adequate intraoperative anesthesia and postoperative analgesia were achieved with the deposition of LA beneath the axillary artery. [ABSTRACT FROM AUTHOR]

Abstract Introduction Disasters and accidents have occurred with increasing frequency in recent years. Primary disasters have the potential to result in mass casualty events involving crush syndrome (CS) and other serious injuries. Prehospital providers and emergency clinicians stand on the front lines of these patients’ evaluation and treatment. However, the bulk of our current knowledge, derived from historical data, has remained unchanged for over ten years. In addition, no evidence-based treatment has been established to date. Objective This narrative review aims to provide a focused overview of, and update on, CS for both prehospital providers and emergency clinicians. Discussion CS is a severe systemic manifestation of trauma and ischemia involving soft tissue, principally skeletal muscle, due to prolonged crushing of tissues. Among earthquake survivors, the reported incidence of CS is 2–15%, and mortality is reported to be up to 48%. Patients with CS can develop cardiac failure, kidney dysfunction, shock, systemic inflammation, and sepsis. In addition, late presentations include life-threatening systemic effects such as hypovolemic shock, hyperkalemia, metabolic acidosis, and disseminated intravascular coagulation. Immediately beginning treatment is the single most important factor in reducing the mortality of disaster-situation CS. In order to reduce complications from CS, early, aggressive resuscitation is recommended in prehospital settings, ideally even before extrication. However, in large-scale natural disasters, it is difficult to diagnose CS, and to reach and start treatments such as continuous administration of massive amounts of fluid, diuresis, and hemodialysis, on time. This may lead to delayed diagnosis of, and high on-site mortality from, CS. To overcome these challenges, new diagnostic and therapeutic modalities in the CS animal model have recently been advanced. Conclusions Patient outcomes can be optimized by ensuring that prehospital providers and emergency clinicians maintain a comprehensive understanding of CS. The field is poised to undergo significant advances in coming years, given recent developments in what is considered possible both technologically and surgically; this only serves to further emphasize the importance of the field, and the need for ongoing research.

The majority of infection-related deaths following earthquake injuries are caused by nosocomial infections, particularly in those receiving hemodialysis. Central venous catheter-related blood-stream infections, deep wound infections secondary to fasciotomy, and ventilator-associated pneumonias ranked as the top 3 causes of sepsis and mortality. Acinetobacter baumannii and Pseudomonas aeruginosa are among the leading causes. It is of vital importance to protect patients from nosocomial infections, who are rescued from rubble. Avoiding unnecessary fasciotomy, using appropriate empirical/pre-emptive antimicrobial therapy, ensuring full compliance with infection control measures, and referring patients to appropriate centers are all critical for decreasing mortality. All components of infection control program must be strictly adhered to, clinical samples and colonization scans of the patients should be followed dynamically and the treatment protocols should be modified according to culture results and local epidemiology. Whether the wound is closed or open, all crush injuries are regarded as tetanus-prone wounds. Tetanus prophylaxis (vaccine+immunoglobulin, if necessary) should be administered to all patients at risk. For patients with closed wounds, 24-hour prophylaxis is recommended. Ampicillinsulbactam is the best antibiotic for prophylaxis, with a potential coverage over environmental Acinetobacter strains. For patients with open wounds, all should be considered contaminated. Cultures (blood culture, wound culture, urine culture, and respiratory sample, if any) should be obtained after prompt wound cleaning and debridement. If the wound does not appear infected and cultures turn negative, a 5-day pre-emptive antibiotic therapy with ampicillin-sulbactam is sufficient. [ABSTRACT FROM AUTHOR]

Kahramanmaraş was hit by two major earthquakes nine hours apart on February 6th, 2023, with magnitudes of 7.8 and 7.5 on the Richter scale, respectively. Ten other cities were also devastatingly affected by these earthquakes. More than 50 thousand people died in Turkey. The occurrence of two severe earthquakes on the same day in such a wide geographical area caused significant challenges. This disaster, with its devastating effects, focused attention on the significance of establishing a national and comprehensive emergency disaster plan prior to any disaster. Additionally, it highlighted the necessity of preparing a well-organized healthcare team capable of providing prompt and appropriate fluid replacement for pediatric patients in the early stages of a disaster. This is a crucial issue which must be addressed prior to major disasters. Another very important issue in this tragic disaster was the condition of chronically ill pediatric patients. Indeed, an emergency response is important not only for disaster victims, but also for those patients with chronic diseases in need of uninterrupted medical care. It is vital that individuals of all ages, as well as personnel from all sectors, receive the appropriate education, awareness, and knowledge on what actions to take, where to go, and where to gather in such situations. [ABSTRACT FROM AUTHOR]

Introduction: Earthquakes are sudden-onset natural disasters that are associated with substantial material damage, resulting in the collapse of built environment with a high rate of mortality, injury, and disability. Crush syndrome, which can be seen after devastating earthquakes, can lead to acute kidney injury (AKI) and patients may require amputation, fasciotomy, and dialysis. Supportive treatment has an important role in the prognosis of these patients. Study Objective: The aim of this study was to investigate the demographic and clinical characteristics of traumatic earthquake survivors admitted to the emergency department (ED) of a hospital, which was close to the earthquake zone but not affected by the earthquake, after the February 6, 2023 Kahramanmaraş (Turkey) earthquakes. Materials and Methods: This study was conducted by retrospectively analyzing the data of 1,110 traumatized earthquake survivors admitted to the ED of a tertiary care university hospital from February 6th through February 20th, 2023. Age; gender; time of presentation; presence of comorbid diseases; ED triage category; duration of stay under debris; presence of additional trauma; laboratory tests; presence of AKI; presence of crush injury and injury sites; supportive treatment (fluid replacement and intravenous [IV] sodium bicarbonate); need for amputation, dialysis, and fasciotomy; duration of hospitalization; and outcome of ED were evaluated. Results: Of the 1,110 traumatic victims in this study, 55.5% were female patients. The mean age of the patients was 45.94 (SD = 16.7) years; the youngest was 18 years old and the oldest was 95 years old. Crush injury was detected in 18.8% and AKI in 3.0% of the patients. Dialysis, amputation, and fasciotomy were required in 1.6%, 2.8%, and 1.4% of the patients, respectively. In total, 29.2% of patients were hospitalized, including 2.9% admitted to the intensive care unit (ICU) and 26.3% to the relevant ward. In total, 0.3% of the patients included in the study died at ED. Conclusion: Post-earthquake patients may present with crush injury, AKI may develop, and fasciotomy, amputation, and dialysis may be needed, so hospitals and EDs should be prepared for natural disasters such as earthquakes. [ABSTRACT FROM AUTHOR]

Protective vs. Therapeutic Effects of Mitochondria-Targeted Antioxidant MitoTEMPO on Rat Sciatic Nerve Crush Injury: A Comprehensive Electrophysiological Analysis. Peripheral nerve injuries often result in long-lasting functional deficits, prompting the need for effective interventions. MitoTEMPO (2-(2,2,6,6-tetramethylpiperidin-1-oxyl-4-ylamino)-2-oxoethyl) triphenylphosphonium chloride) is a mitochondria-targeted antioxidant that has shown protective and therapeutic effects against pathologies associated with reactive oxygen species. This study explores the utilization of MitoTEMPO as a therapeutic and protective agent for sciatic nerve crush injuries. By employing advanced mathematical approaches, the study seeks to comprehensively analyze nerve conduction parameters, nerve excitability, and the distribution of nerve conduction velocities to gauge the potential. Forty Wistar-Albino rats were randomly divided into following groups: (I) SHAM—animals subjected to sham operation and treated intraperitoneally (i.p.) with vehicle (bidistilled water) for 14 days; (II) CI (crush injury)—animals subjected to CI and treated with vehicle 14 days; (III) MiP—animals subjected to 7 days i.p. MitoTEMPO treatment before CI (0.7 mg/kg/day dissolved in vehicle) and, only vehicle for 7 days after CI, protective MitoTEMPO; and (IV) MiT—animals i.p. treated with only vehicle for 7 days before CI and 7 days with MitoTEMPO (0.7 mg/kg/day dissolved in vehicle) after CI, therapeutic MitoTEMPO. Nerve excitability parameters were measured, including rheobase and chronaxie, along with compound action potential (CAP) recordings. Advanced mathematical analyses were applied to CAP recordings to determine nerve conduction velocities and distribution patterns. The study revealed significant differences in nerve excitability parameters between groups. Nerve conduction velocity was notably reduced in the MiP and CI groups, whereas CAP area values were diminished in the MiP and CI groups compared to the MiT group. Furthermore, CAP velocity was lower in the MiP and CI groups, and maximum depolarization values were markedly lower in the MiP and CI groups compared to the SHAM group. The distribution of nerve conduction velocities indicated alterations in the composition of nerve fiber groups following crush injuries. In conclusion, postoperative MitoTEMPO administration demonstrated promising results in mitigating the detrimental effects of nerve crush injuries. [ABSTRACT FROM AUTHOR]

Introduction: Disasters and accidents have occurred with increasing frequency in recent years. Primary disasters have the potential to result in mass casualty events involving crush syndrome (CS) and other serious injuries. Prehospital providers and emergency clinicians stand on the front lines of these patients' evaluation and treatment. However, the bulk of our current knowledge, derived from historical data, has remained unchanged for over ten years. In addition, no evidence-based treatment has been established to date. Objective: This narrative review aims to provide a focused overview of, and update on, CS for both prehospital providers and emergency clinicians. Discussion: CS is a severe systemic manifestation of trauma and ischemia involving soft tissue, principally skeletal muscle, due to prolonged crushing of tissues. Among earthquake survivors, the reported incidence of CS is 2–15%, and mortality is reported to be up to 48%. Patients with CS can develop cardiac failure, kidney dysfunction, shock, systemic inflammation, and sepsis. In addition, late presentations include life-threatening systemic effects such as hypovolemic shock, hyperkalemia, metabolic acidosis, and disseminated intravascular coagulation. Immediately beginning treatment is the single most important factor in reducing the mortality of disaster-situation CS. In order to reduce complications from CS, early, aggressive resuscitation is recommended in prehospital settings, ideally even before extrication. However, in large-scale natural disasters, it is difficult to diagnose CS, and to reach and start treatments such as continuous administration of massive amounts of fluid, diuresis, and hemodialysis, on time. This may lead to delayed diagnosis of, and high on-site mortality from, CS. To overcome these challenges, new diagnostic and therapeutic modalities in the CS animal model have recently been advanced. Conclusions: Patient outcomes can be optimized by ensuring that prehospital providers and emergency clinicians maintain a comprehensive understanding of CS. The field is poised to undergo significant advances in coming years, given recent developments in what is considered possible both technologically and surgically; this only serves to further emphasize the importance of the field, and the need for ongoing research. [ABSTRACT FROM AUTHOR]

Crush syndrome (CS), also known as traumatic rhabdomyolysis, is a syndrome with a wide clinical spectrum; it is caused by external compression, which often occurs in earthquakes, wars, and traffic accidents, especially in large-scale disasters. Crush syndrome is the second leading cause of death after direct trauma in earthquakes. A series of clinical complications caused by crush syndrome, including hyperkalemia, myoglobinuria, and, in particular, acute kidney injury (AKI), is the main cause of death in crush syndrome. The early diagnosis of crush syndrome, the correct evaluation of its severity, and accurate predictions of a poor prognosis can provide personalized suggestions for rescuers to carry out early treatments and reduce mortality. This review summarizes various methods for the diagnostic and predictive evaluation of crush syndrome, including urine dipstick tests for a large number of victims, traditional and emerging biomarkers, imaging-assisted diagnostic methods, and developed evaluation models, with the aim of providing materials for scholars in this research field. [ABSTRACT FROM AUTHOR]

Currently, despite decades of trial and error, peripheral nerve injury is an impenetrable clinical dilemma. Any proven effective pharmacologic agent leads to a decisive leap forward to the clinical management of neuropathies. This study investigated the effects of tacrolimus and erythropoietin on sciatic nerve regeneration. Twenty-three mice were randomly assigned to tacrolimus, erythropoietin, tacrolimus + erythropoietin, control, and sham groups following sciatic nerve crush via hemostatic forceps. Medications were administered for 28 consecutive days. The sham group received neither crush injury nor medication. Histopathologic, immunohistochemical, and walking track analyses were performed. In the erythropoietin group, axonal swelling was significantly reduced and the average axonal number significantly recovered up to 75% of normal nerve compared to other groups. Marked immunoreactivity to GFAP and S-100 protein was present in the tacrolimus group. Nevertheless, at least moderate GFAP and S-100 expressions were observed in all of the groups. Functional recovery was superior in the tacrolimus group after 14 days, although a complete return to near-normal function was achieved in all groups after 28 days, regardless of the medication used. Our data supported the neurotrophic effects of tacrolimus and erythropoietin; however, not enough data was gathered to confirm their synergistic effects. Whether these results are extensible to clinical scenarios requires further detailed investigations. [ABSTRACT FROM AUTHOR]

Background: We aimed to describe the demographic, injury-related, and treatment-related characteristics of patients who undergo fasciotomies for acute hand compartment syndrome. Methods: A cohort of 53 adult patients with acute hand compartment syndrome treated with fasciotomy at 2 tertiary care referral centers over a 10-year time period from January 1, 2006, to June 30, 2015, were retrospectively identified. We reviewed the electronic medical record for patient-related variables (eg, age, sex, smoking status, diabetes mellitus), injury-related variables (eg, mechanism of injury, presence of fractures), and treatment-related variables (eg, compartments released, number of operations, use of split-thickness skin grafts, and time from injury to surgery). Results: The mean age of our cohort was 45 years, and 33 patients (62%) were men. The mechanism of injury varied widely, but the most common causative mechanisms were crush injury (25%), prolonged decubitus (17%), and infection (11%). Associated hand fractures were present in 15 (28%) patients. The surgically released compartments varied; the dorsal interosseous compartments (83%), thenar compartment (75%), and hypothenar compartment (74%) were most frequently released, while the adductor pollicis compartment (43%) and Guyon canal (28%) were least frequently released. Conclusions: The demographics of acute hand compartment syndrome have evolved in the last 25 years compared with the prior literature, partly as a result of the opioid epidemic leading to a rise in "found down" compartment syndrome. Treating providers should recognize crush injury, prolonged decubitus, and infection as the most common causes of acute hand compartment syndrome. [ABSTRACT FROM AUTHOR]

Crush injury is one of the most challenging decisions for a surgeon to decide whether to proceed with an amputation or salvage a limb.We presented a 24-year-old man who complained of having suffered a crushed thigh 12 h before admission to the hospital. The patient was driving a truck and hit the iron bridge barrier, which penetrated his left thigh. The patient's left foot was cold, pallid, and pulseless, with a MESS score of 11. The femur x-ray showed a displaced fracture of the left femur associated with a 15 cm bone defect. The patient was diagnosed with a crush injury on the left femur with vascular compromise.We performed a proximal femoral megaprosthesis for a crush injury on the lower extremity, After the sixth year's follow-up, it shows a good outcome and increased quality of life for this patient. In addition, there was an improvement in the Harris Hip Score and EQ5D score.Megaprosthesis used to treat a crush injury revealed good functional outcomes despite the MESS score of 11. A multi-professional approach to the patient is essential for decision-making regarding limb salvage rather than the use of a score.

Background: Fibrosis occurs during the healing process after nerve injury. Extraneural fibrosis occurs around the epineural sheath. Intraneural fibrosis occurs in the internal structure of the nerve. Prophylactic treatment with silicone gel sheets is effective in preventing severe scarring in the skin. Nerve action potential (NAP) recording is a well established, simple, and useful tool in the surgical treatment of nerve damage. Our aim in this study was to determine the effect of a silicone sheet on biophysical and histopathologic parameters when used in the treatment of peripheral nerve transection (neurotmesis) and crush injuries. Methods: The study was conducted with 32 Wistar albino male rats. The rats in the neurotmesis and crush injury groups were divided into study and control groups. Before the injury and after 12 weeks, electrophysiological measurements were obtained. The sciatic nerve biopsy specimens were histopathologically evaluated. Results: After 12 weeks, there was no statistical difference between pre- and post-injury ΔPP values in the PNR+SS group (p = 0.123). There was no statistically significant difference in post-injury ΔPP values between the CI and CI+SS groups (p = 0.201). The mean total histopathological score was significantly higher in the PNR+SS group than in the PNR group (p = 0.023). Conclusions: In this rat model, a silicone sheet appears to have positive effects on peripheral nerve healing after primer repair and crush injury. Level of evidence: Not gradable. [ABSTRACT FROM AUTHOR]

Primary disasters may result in mass casualty events with serious injuries, including crush injury and crush syndrome. This narrative review provides a focused overview of crush injury and crush syndrome for emergency clinicians. Millions of people worldwide annually face natural or human-made disasters, which may lead to mass casualty events and severe medical issues including crush injury and syndrome. Crush injury is due to direct physical trauma and compression of the human body, most commonly involving the lower extremities. It may result in asphyxia, severe orthopedic injury, compartment syndrome, hypotension, and organ injury (including acute kidney injury). Crush syndrome is the systemic manifestation of severe, traumatic muscle injury. Emergency clinicians are at the forefront of the evaluation and treatment of these patients. Care at the incident scene is essential and focuses on treating life-threatening injuries, extrication, triage, fluid resuscitation, and transport. Care at the healthcare facility includes initial stabilization and trauma evaluation as well as treatment of any complication (e.g., compartment syndrome, hyperkalemia, rhabdomyolysis, acute kidney injury). Crush injury and crush syndrome are common in natural and human-made disasters. Emergency clinicians must understand the pathophysiology, evaluation, and management of these conditions to optimize patient care. [ABSTRACT FROM AUTHOR]

Abstract Background Traumatic peripheral nerve injury (TPNI) is a major medical problem with no universally accepted pharmacologic treatment. We hypothesized that encapsulation of pro-angiogenic erythropoietin (EPO) in amphiphilic PLGA-PEG block copolymers could serve as a local controlled-release drug delivery system to enhance neurovascular regeneration after nerve injury. Methods In this study, we synthesized an EPO-PLGA-PEG block copolymer formulation. We characterized its physiochemical and release properties and examined its effects on functional recovery, neural regeneration, and blood vessel formation after sciatic nerve crush injury in mice. Results EPO-PLGA-PEG underwent solution-to-gel transition within the physiologically relevant temperature window and released stable EPO for up to 18 days. EPO-PLGA-PEG significantly enhanced sciatic function index (SFI), grip strength, and withdrawal reflex post-sciatic nerve crush injury. Furthermore, EPO-PLGA-PEG significantly increased blood vessel density, number of junctions, and myelinated nerve fibers after injury. Conclusion This study provides promising preclinical evidence for using EPO-PLGA-PEG as a local controlled-release treatment to enhance functional outcomes and neurovascular regeneration in TPNI.

Aim: Crush injury damages the nerve, affects its function and causes oxidative stress. Alpha-lipoic acid (ALA) is an antioxidant agent with protective effects on the nerve tissue. In this study, we aimed to investigate the effects of ALA in the treatment of crush sciatic nerve injury in rats. Materials and Methods: Forty rats were divided into five groups. Walking Track Analysis (WTA) was performed in all groups before sacrificing the sciatic nerve. In group I (sham group), the sciatic nerve was exposed but not crushed, whereas in group II (early control group, 24th hour), group III (late control group, 7th day), group IV (early experimental group, 24th hour), and group V (late control group, 7th day), the sciatic nerve was exposed and clipped with an aneurysm clip for 300 seconds. One hour after the crush injury, subjects in groups II and III were given saline (2.5 ml, intraperitoneally), while ALA (100 mg/kg, intraperitoneally) was administered in Groups IV and V. WTA was performed in Groups I, II, and IV at the 24th hour after clipping and was performed in Groups III and V at 7th day after clipping. In all groups, the Sciatic Functional Index (SFI) was calculated after WTA. Following the completion of WTA, sciatic nerve tissue samples were obtained for the measurement of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) enzyme values. Results: The SFI scores in groups II, III, IV, and V were significantly lower than that of sham group (p<0.05), while no significant difference was found between groups II and IV and between groups III and V (p>0.05). The CAT values of groups II and IV, the GSH-Px value and MDA value of group IV, and the SOD values of groups II and IV were found to be significantly higher than those of sham group (p<0.05). However, no significant difference was found among groups I, III, and V with regard to CAT, GSH-Px, MDA and SOD values (p>0.05). Conclusion: The results indicated that a single dose of ALA (100 mg/kg) administered intraperitoneally one hour after the sciatic nerve crush injury had no therapeutic efficacy at 24 hours and 7 days after the administration. Further experimental studies are needed to evaluate the effectiveness of ALA applied in several doses rather than a single dose in crush peripheral nerve injury models. [ABSTRACT FROM AUTHOR]