Pediatric earthquake-related amputations: associations with fasciotomy, crush syndrome, and entrapment duration

Pediatric earthquake victims face unique challenges due to their distinct physiology, vulnerability to crush and compartment syndromes, and long-term functional and psychosocial needs. While adult earthquake-related amputations have been described, comprehensive pediatric-focused analyses remain scarce.

We conducted a retrospective study of 54 pediatric patients who underwent earthquake-related amputations following the February 6, 2023, Türkiye double earthquakes. Demographics, amputation characteristics, fasciotomy, crush syndrome, entrapment under debris, intensive care unit (ICU) admission, and early outcomes were systematically evaluated.

Lower extremity amputations predominated (79.6%), with bilateral limb loss in 18.5% of patients. Fasciotomy was performed in 40.7% and was associated with shorter entrapment duration (p = 0.023), longer hospitalization (p = 0.027), and absence of debris entrapment (p = 0.019). Crush syndrome (25.9%) was linked to longer hospital stay (p = 0.017) and higher ICU admission (p = 0.043). Debris entrapment (13.0%) significantly increased the risk of thoracic trauma (p = 0.046) and ICU requirement (p = 0.033). Notably, no fasciotomy was performed in entrapped children. Older age, crush syndrome, and debris entrapment were significantly associated with ICU admission.

This study provides an early description of pediatric earthquake-related amputations. Fasciotomy appeared most beneficial when performed shortly after rescue, whereas prolonged entrapment was linked to systemic compromise and critical care needs. Crush syndrome was associated with greater resource utilization. These early descriptive findings underscore the importance of pediatric-specific considerations in disaster preparedness and highlight priorities for future multicenter and comparative research.