SEVERE UPPER EXTREMITY CRUSH SYNDROME IN A NON-DISASTER SETTING: A CASE REPORT OF SUCCESSFUL MULTIMODAL MANAGEMENT...

Crush syndrome is a severe systemic condition caused by prolonged compression of skeletal muscles, leading to ischemia-reperfusion injury and traumatic rhabdomyolysis. It is most commonly associated with natural disasters and predominantly affects the lower extremities, whereas isolated upper extremity involvement in non-disaster settings is rare.

To present a rare case of severe crush syndrome of the upper extremity in a non-disaster setting and to evaluate the effectiveness of early multimodal treatment.

A 28-year-old male developed crush syndrome after 6-8 hours of prolonged compression of the left upper extremity following loss of consciousness. Clinical, laboratory, and instrumental data were analyzed. The patient underwent early fasciotomy, intensive care management, therapeutic plasma exchange (4 sessions), and renal replacement therapy (5 sessions of hemodialysis).

The patient developed severe rhabdomyolysis (creatine kinase up to 93,994 U/L), acute kidney injury (creatinine up to 740 µmol/L), hyperkalemia, and multi-organ dysfunction. Early fasciotomy revealed initially non-viable muscle tissue with subsequent partial recovery of viability. Combined treatment resulted in significant clinical improvement, restoration of diuresis (up to 4800 mL/day), and complete recovery of renal function.

Severe upper extremity crush syndrome in non-disaster conditions can have a favorable outcome when managed with early and aggressive multimodal therapy. Early surgical decompression combined with therapeutic plasma exchange and hemodialysis may significantly improve prognosis and reduce mortality and long-term disability.