Injuries during massive disasters like earthquakes are high energy injuries result in severe soft tissue trauma and open fractures. The amount of weight of the wreck and more importantly, time spent staying under the rubble of the damaged buildings directly effects the degree of the damage. There may be delays in the emergency management of the injured patients due to the lack of satisfactory hospital facilities and health personnel. The earthquake victims who can be transferred to a hospital in the first 6-8 hours can be succesfully managed by a proper fasciotomy without resulting in any functional damage and the limb can be saved. Besides, further life threatening metabolic changes can also be prevented. The clinical findings of late presentation earthquake victims who could be transfeered to a hospital in 8-24 hours may begin to alterate and the indications of fasciotomy may be more limited. Even more selective surgical management should be considered in earthquake victims with very late presentation to the hospitals with crush syndrome. Only hospitals with full functioning services of all clinics including plastic and reconstructive surgery, with no lack of health personnel who can provide serial debridements of the injured limbs in operation theatre settings may consider of performing fasciotomy in earthquake victims with crush syndrome. One should keep in mind that a improperly performed fasciotomy may result in infection and thus amputation. Amputations may be considered as an alternative strategy in crush syndrome patients with severly injures limbs with accompanying vascular damage, in whom infections can be life threatening.