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Objective To determine the features that differentiate earthquake-related crush extremity fractures from non-earthquake-related extremity fractures by using digital radiography ( DR) and multidetector row computed tomography ( MDCT). Methods Six hundred and twenty-three consecutive victims with crush extremity fractures arising from the 2008 Sichuan earthquake, including 611 undergoing DR and 12 undergoing MDCT, entered the test group, and 316 consecutive victims with non-earthquake-related extremity fractures, including 301 undergoing DR and 15 undergoing MDCT, were enrolled in the control group. Image data were reviewed retrospectively and statistically between groups focusing on the anatomic distributions, numbers and types of extremity fractures. Results Fractures involving multiple extremities were more likely in the test group than the control group (88/623 vs 27/316 victims, P < 0.05). Fractures involving multiple bones (336/623 vs 112/316 victims) and comminuted fractures (324/623 vs 78/316 victims) were seen more frequently in the test group than the control group with both occurring predominantly in the tibia and fibula (all P < 0.05). Conclusion Earthquake-related crush fractures of extremities are more likely than non-earthquake-related extremity fractures to involve multiple extremities, multiple bones and to be comminuted. The lower extremities, predominantly the tibia and fibula, are more likely to be involved. This has implications for emergency and disaster planning in earthquake-prone regions. [ABSTRACT FROM AUTHOR]