Beyond the Fall: Compression-Induced Rhabdomyolysis, Acute Kidney Injury, and Functional Outcomes in Older Adults

Prolonged immobilization following falls represents an underrecognized clinical complication in older adults, particularly among individuals with frailty, multimorbidity, and reduced physiological reserves. Sustained skeletal muscle compression may induce ischemic injury, rhabdomyolysis, electrolyte disturbances, and acute kidney injury (AKI), potentially compromising survival and long-term functional independence. This narrative review examines the epidemiological characteristics, pathophysiological mechanisms, clinical manifestations, prognostic factors, therapeutic approaches, and functional outcomes associated with prolonged post-fall immobilization. A structured analysis of 20 scientific publications was conducted, integrating international evidence and relevant Latin American perspectives from traumatology, geriatrics, and nephrology. The reviewed findings identified falls, with or without immobilization, as the predominant cause of rhabdomyolysis in a geriatric cohort, accounting for 56.9% of cases. Acute renal failure was documented in 57.7% of patients in a separate hospitalized rhabdomyolysis cohort, while biochemical abnormalities involving phosphate, bicarbonate, and renal function were associated with adverse clinical outcomes. Functional deterioration was also documented following geriatric falls, with 29.6% of patients experiencing clinically significant decline at 180 days in a separate prospective cohort. These findings emphasize the interconnected nature of muscular, renal, and functional complications, although the reported frequencies originate from heterogeneous populations and cannot be interpreted as combined estimates for post-fall crush syndrome. Early clinical recognition, individualized fluid management, renal monitoring, and multidisciplinary rehabilitation emerge as important components of comprehensive care. Further prospective investigations, particularly in Latin America, are required to clarify geriatric-specific prognostic indicators and long-term recovery trajectories.