Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Apr 18, 2025; 16(4): 104489
Published online Apr 18, 2025. doi: 10.5312/wjo.v16.i4.104489
Pathophysiology and management of crush syndrome: A narrative review
Shahnawaz Khan, Deepak Neradi, Nikhil Unnava, Mantu Jain, Sujit Kumar Tripathy
Shahnawaz Khan, Deepak Neradi, Nikhil Unnava, Mantu Jain, Sujit Kumar Tripathy, Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar 751019, India
Author contributions: Khan S, Neradi D, and Unnava N designed the concept, searched the literature, and extracted the data; Khan S and Tripathy SK prepared the manuscript; Jain M and Tripathy SK provided the intellectual content; All authors read the article and approved it for publication.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sujit Kumar Tripathy, Professor, Department of Orthopedics, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar 751019, India. sujitortho@yahoo.co.in
Received: December 23, 2024
Revised: March 19, 2025
Accepted: March 20, 2025
Published online: April 18, 2025
Processing time: 116 Days and 5.6 Hours
Abstract
BACKGROUND

Crush syndrome refers to the traumatic rhabdomyolysis leading to a spectrum of disorders culminating in acute kidney injury. The burden of crush syndrome is high, and mortality can be as high as 20%. The significant bulk of knowledge is from old articles. Over the last 10 years new research has occurred on diagnosis and treatment in animal models.

AIM

To overview of crush syndrome and discuss the newer advances related to the pathogenesis and management of a patient with crush syndrome.

METHODS

The search of databases such as MEDLINE, Google Scholar, Web of Science, and EMBASE revealed 8226 articles. A thorough screening culminated in 83 crush syndrome articles included in this study.

RESULTS

Acute kidney injury in crush syndrome is currently thought to be due to iron retention. The management of crush syndrome has also been updated with antioxidants, and several gases are being used to treat crush syndrome. In the end, treatment of crush syndrome also includes mental, social, and physical rehabilitation for better outcomes.

CONCLUSION

The outcomes of crush syndrome have significantly improved with the introduction of newer treatment modalities, including antioxidants, hyperbaric oxygen therapy, and comprehensive mental, social, and physical rehabilitation.

Keywords: Rhabdomyolysis; Fracture; Musculoskeletal injury; Acute kidney injury; Myoglobin; Muscle

Core Tip: Crush syndrome is a life-threatening condition caused by traumatic rhabdomyolysis, resulting in systemic complications, particularly acute kidney injury. Pathophysiologically, muscle damage releases toxins such as myoglobin, potassium, and lactic acid into the bloodstream, leading to renal tubule damage, hyperkalemia-induced cardiac arrhythmias, metabolic acidosis, and coagulopathy. Modern insights highlight the role of ferroptosis, oxidative stress, and macrophage activity in acute kidney injury progression. Management emphasizes early recognition, fluid resuscitation, renal protection, and innovative therapies like antioxidants, hyperbaric oxygen, and erythropoietin. Comprehensive treatment also includes pre-hospital care, electrolyte correction, renal replacement therapy, and long-term rehabilitation to improve outcomes and quality of life.