Crush Syndrome and Systemic Necrosis in Trauma Patients: A Systematic Review of Pathophysiology, Anatomical Impact, and Renal Outcomes

Abstract

Crush syndrome remains a life-threatening complication of traumatic injuries, especially in mass casualty and disaster scenarios. This systematic review evaluates the current clinical and mechanistic understanding of crush-related pathophysiology, anatomical impact, and renal complications, with a focus on therapeutic interventions. Studies were selected using the PICO framework and analyzed under PRISMA guidelines. A total of six studies, including narrative reviews, clinical trials, and a systematic review, were included. Core findings highlighted ischemia-reperfusion injury, rhabdomyolysis, and ferroptosis as key drivers of systemic toxicity, often culminating in acute kidney injury (AKI). Anatomically, prolonged soft tissue compression and necrosis posed serious risks for long-term disability and systemic inflammation. Adjunctive therapies such as hyperbaric oxygen therapy (HBOT) demonstrated potential benefits in wound healing and tissue preservation, though evidence remains limited by study heterogeneity. Overall, this review offers an integrative synthesis of existing knowledge, identifies therapeutic gaps, and emphasizes the need for standardized, evidence-based protocols for managing crush syndrome.