Q: My 20 years old friend's son met with an accident on last month. He was found to have compound fractures on left femur. He was operated in a private hospital in Bangalore and he has developed rhabdomyolysis and acute renal failure and he was referred to another hospital in Bangalore for further management after fasciotomy. He underwent repeated wound dressings and debridements. On last debridement it was found that a part from lateral and medical compartments, even the posterior compartment was completely necrosed. Keeping in mind the post renal failure status and potential chance of a hemorrhage from the vascular blowout, he was advised to undergo amputation at the appropriate level and this has to be performed before tomorrow. What are my friend’s chances of recovering from rhabdomyolysis?

A:Trauma is one of the leading causes of rhabdomyolysis. Acute renal failure occurs in about two thirds of cases of rhabdomyolysis. If the treatment is instituted soon after the diagnosis, prognosis improves markedly. The treatment primarily includes hydration, correction of electrolyte abnormalities and probable surgical management of compartment syndrome and crush injury. The decision about the amputation depends on a clinical score called, Mangled Extremity Severity Score (MESS). This scoring system is based on the degree of skeletal / soft tissue injury, rating of blood pressure, pulse and age. The higher the score, the higher is the predictive value of requirement for amputation. Please discuss with the surgical team about this. Also, please involve a nephrologist in taking care of your friend's son for management of hydration and electrolyte abnormalities in the setting of acute renal failure.