Journal of Trauma and Injury

A decade of treating traumatic sternal fractures in a single-center experience in Korea: a retrospective cohort study: Na Hyeon Lee, Seon Hee Kim, Jae Hun Kim, Ho Hyun Kim, Sang Bong Lee, Chan Ik Park, Gil Hwan Kim, Dong Yeon Ryu, Sun Hyun Kim; J Trauma Inj. 2023;36(4):362-368. Published online November 30, 2023; DOI: https://doi.org/10.20408/jti.2023.0027

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Abstract PDF: Purpose
Clinical reports on treatment outcomes of sternal fractures are lacking. This study details the clinical features, treatment approaches, and outcomes related to traumatic sternal fractures over a 10-year period at a single institution.
Methods
A retrospective cohort study was conducted of patients admitted to a regional trauma center between January 2012 and December 2021. Among 7,918 patients with chest injuries, 266 were diagnosed with traumatic sternal fractures. Patient data were collected, including demographics, injury mechanisms, severity, associated injuries, sternal fracture characteristics, hospital stay duration, mortality, respiratory complications, and surgical details. Surgical indications encompassed emergency cases involving intrathoracic injuries, unstable fractures, severe dislocations, flail chest, malunion, and persistent high-grade pain.
Results
Of 266 patients with traumatic sternal fractures, 260 were included; 98 underwent surgical treatment for sternal fractures, while 162 were managed conservatively. Surgical indications ranged from intrathoracic organ or blood vessel injuries necessitating thoracotomy to unstable fractures with severe dislocations. Factors influencing surgical treatment included flail motion and rib fracture. The median length of intensive care unit stay was 5.4 days (interquartile range [IQR], 1.5–18.0 days) for the nonsurgery group and 8.6 days (IQR, 3.3–23.6 days) for the surgery group. The median length of hospital stay was 20.9 days (IQR, 9.3–48.3 days) for the nonsurgery group and 27.5 days (IQR, 17.0 to 58.0 days) for the surgery group. The between-group differences were not statistically significant. Surgical interventions were successful, with stable bone union and minimal complications. Flail motion in the presence of rib fracture was a crucial consideration for surgical intervention.
Conclusions
Surgical treatment recommendations for sternal fractures vary based on flail chest presence, displacement degree, and rib fracture. Surgery is recommended for patients with offset-type sternal fractures with rib and segmental sternal fractures. Surgical intervention led to stable bone union and minimal complications.; Summary

Clinical characteristics of patients with the hardware failure after surgical stabilization of rib fractures in Korea: a case series: Na Hyeon Lee, Sun Hyun Kim, Seon Hee Kim, Dong Yeon Ryu, Sang Bong Lee, Chan Ik Park, Hohyun Kim, Gil Hwan Kim, Youngwoong Kim, Hyun Min Cho; J Trauma Inj. 2023;36(3):196-205. Published online September 5, 2023; DOI: https://doi.org/10.20408/jti.2023.0026

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Purpose
Surgical stabilization of rib fractures (SSRF) is widely used in patients with flail chests, and several studies have reported the efficacy of SSRF even in multiple rib fractures. However, few reports have discussed the hardware failure (HF) of implanted plates. We aimed to evaluate the clinical characteristics of patients with HF after SSRF and further investigate the related factors.
Methods
We retrospectively reviewed the electronic medical records of patients who underwent SSRF for multiple rib fractures at a level I trauma center in Korea between January 2014 and January 2021. We defined HF as the unintentional loosening of screws, dislocation, or breakage of the implanted plates. The baseline characteristics, surgical outcomes, and types of HF were assessed.
Results
During the study period, 728 patients underwent SSRF, of whom 80 (10.9%) were diagnosed with HF. The mean age of HF patients was 56.5±13.6 years, and 66 (82.5%) were men. There were 59 cases (73.8%) of screw loosening, 21 (26.3%) of plate breakage, 17 (21.3%) of screw migration, and seven (8.8%) of plate dislocation. Nine patients (11.3%) experienced wound infection, and 35 patients (43.8%) experienced chronic pain. A total of 21 patients (26.3%) underwent reoperation for plate removal. The patients in the reoperation group were significantly younger, had fewer fractures and plates, underwent costal fixation, and had a longer follow-up. There were no significant differences in subjective chest symptoms or lung capacity.
Conclusions
HF after SSRF occurred in 10.9% of the cases, and screw loosening was the most common. Further longitudinal studies are needed to identify risk factors for SSRF failure.

Summary

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Komplikationen nach operativer vs. konservativer Versorgung des schweren Thoraxtraumas
Lars Becker, Marcel Dudda, Christof Schreyer
Die Unfallchirurgie.2024; 127(3): 204. CrossRef

Effects of Massive Transfusion Protocol Implementation in Trauma Patients at a Level I Trauma Center: Hyun Woo Sun, Sang Bong Lee, Sung Jin Park, Chan Ik Park, Jae Hun Kim; J Trauma Inj. 2020;33(2):74-80. Published online June 30, 2020; DOI: https://doi.org/10.20408/jti.2020.022

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Abstract PDF

Purpose

This study was conducted to investigate whether rapid and efficient administration of blood products was achieved and whether clinical outcomes were improved by applying a massive transfusion protocol (MTP).

Methods

From January 2016 to September 2019, the medical records of trauma patients who received at least 10 units of packed red blood cells (PRBC) at Pusan National University Hospital (level I trauma center) were retrospectively reviewed. The patients treated from January 2016 to January 2018 were designated as the non-MTP group, and those treated from February 2018 to September 2019 were designated as the MTP group.

Results

During the study period, 370 patients received massive transfusions. The non-MTP and MTP groups comprised 84 and 55 patients, respectively. No significant between-group differences were found in the units of PRBC (23.2 vs. 25.3, respectively; p=0.46), fresh frozen plasma (FFP) (21.1 vs. 24.4, respectively; p=0.40), and platelets (PLT) (15.4 vs. 17.0, respectively; p=0.54) administered in the first 24 hours. No statistically significant differences between the non-MTP and MTP groups were found in the FFP-to-PRBC ratio (0.9 vs. 0.94, respectively; p=0.44) and or the PLT-to-PRBC ratio (0.72 vs. 0.72, respectively; p=0.21). However, the total number of cryoprecipitate units was significantly higher in the MTP group than in the non-MTP group (7.4 vs. 15.3 units, respectively; p=0.003) and the ratio of cryoprecipitate to PRBC in the MTP group was significantly higher than in the non-MTP group (0.31 vs. 0.62, respectively; p=0.021). The time to transfusion was significantly reduced after MTP implementation (41.0 vs. 14.9 minutes, respectively; p=0.003).

Conclusions

Although no significant differences were found in the clinical outcomes of patients who had undergone severe trauma, rapid and balanced transfusion was achieved after implementing the MTP.

Summary

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Acquired Factor XIII Deficiency in Patients with Multiple Trauma
Michael Hetz, Tareq Juratli, Oliver Tiebel, Moritz Tobias Giesecke, Serafeim Tsitsilonis, Hanns-Christoph Held, Franziska Beyer, Christian Kleber
Injury.2023; 54(5): 1257. CrossRef

A Peripherally Inserted Central Catheter is a Safe and Reliable Alternative to Short-Term Central Venous Catheter for the Treatment of Trauma Patients: Dong Yeon Ryu, Sang Bong Lee, Gil Whan Kim, Jae Hun Kim; J Trauma Inj. 2019;32(3):150-156. Published online September 30, 2019; DOI: https://doi.org/10.20408/jti.2019.015

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Abstract PDF

Purpose

To determine whether a peripherally inserted central catheter (PICC) meets the goals of a low infection rate and long-term use in trauma patients.

Methods

From January 2016 to June 2018, the medical records of patients who underwent central venous catheterization at a level I trauma center were retrospectively reviewed. Data collected included age, sex, injury severity score, site of catheterization, place of catheterization (intensive care unit [ICU], emergency department, or general ward), type of catheter, length of hospital stay during catheterization, types of cultured bacteria, time to development of central line-associated bloodstream infection (CLABSI), and complications.

Results

During the study period, 333 central vein catheters (CVC) were inserted with a total of 2,626 catheter-days and 97 PICCs were placed with a total of 2,227 catheter-days. The CLABSI rate was significantly lower in the PICC group when the analysis was limited to patients for whom the catheter was changed for the first time in the ICU after CVC insertion in the ER with similar indication and catheter insertion times (18.6 vs. 10.3/1,000 catheter-days, respectively, p<0.05). The median duration of catheter use was significantly longer in the PICC group than in the CVC group (16 vs. 6 days, respectively, p<0.05).

Conclusions

The study results showed that the duration of catheter use was longer and the infection rate were lower in the PICC group than in the CVC group, suggesting that PICC is a safe and reliable alternative to conventional CVC.

Summary

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Anatomical Structures to Be Concerned With During Peripherally Inserted Central Catheter Procedures
Dasom Kim, Jin Woo Park, Sung Bum Cho, Im Joo Rhyu
Journal of Korean Medical Science.2023;[Epub] CrossRef
The incidence and risk of venous thromboembolism associated with peripherally inserted central venous catheters in hospitalized patients: A systematic review and meta-analysis
Anju Puri, Haiyun Dai, Mohan Giri, Chengfei Wu, Huanhuan Huang, Qinghua Zhao
Frontiers in Cardiovascular Medicine.2022;[Epub] CrossRef
Peripherally Inserted Central Catheter lines for Intensive Care Unit and onco-hematologic patients: A systematic review and meta-analysis
Georgios Mavrovounis, Maria Mermiri, Dimitrios G Chatzis, Ioannis Pantazopoulos
Heart & Lung.2020; 49(6): 922. CrossRef

Hepatic Hemangioma Rupture Caused by Blunt Trauma: Gil Hwan Kim, Jae Hun Kim, Sang Bong Lee; J Trauma Inj. 2017;30(4):235-237. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.235

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Abstract PDF

Hepatic hemangioma is the most frequently occurring benign tumor of the liver. Hepatic hemangioma rupture is a rare phenomenon, which can lead to life-threatening conditions. Here, we report a case of hepatic hemangioma rupture caused by blunt trauma. Explorative laparotomy was performed due to unstable vital signs and abdominal massive hemoperitoneum revealed on computed tomography. We detected arterial bleeding from a hepatic hemangioma and performed primary suture of the liver and postoperative angiographic embolization.

Summary

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Post‐traumatic rupture of hepatic haemangioma
Tessa Gaynor, Vanshika Sinh, Jonathan Reddipogu
ANZ Journal of Surgery.2023; 93(11): 2754. CrossRef

Successful Endoscopic Treatment of Hepatic Duct Confluence Injury after Blunt Abdominal Trauma: Case Report: Chan Ik Park, Sung Jin Park, Sang Bong Lee, Kwang Hee Yeo, Seon Uoo Choi, Seon Hee Kim, Jae Hun Kim, Dong Hoon Baek; J Trauma Inj. 2016;29(3):93-97. Published online September 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.3.93

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Abstract PDF: Hepatic duct confluence injury, which is developed by blunt abdominal trauma, is rare. Conventionally, bile duct injury was treated by surgical intervention. In recent decades, however, there had been an increase in radiologic or endoscopic intervention to treat bile duct injury. In a hemodynamically stable patient, endoscopic intervention is considered as the first-line treatment for bile duct injury. A 40 year-old man was transferred to the emergency department of OO trauma center after multiple blunt injuries. Contrast-enhanced abdominal computed tomography performed in another hospital showed a liver laceration with active arterial bleeding, fracture of the sacrum and left inferior pubic ramus, and intraperitoneal bladder rupture. The patient presented with hemorrhagic shock because of intra-peritoneal hemorrhage. After resuscitation, angiographic intervention was performed. After angiographic embolization of the liver laceration, emergency laparotomy was performed to repair the bladder injury. However, there was no evidence of bile duct injury on initial laparotomy. On post-trauma day (PTD) 4, the color of intra-abdominal drainage of the patient changed to a greenish hue; bile leakage was revealed on magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP). Bile leakage was detected near the hepatic duct confluence; therefore, a biliary stent was placed into the left hepatic duct. On PTD 37, contrast leakage was still detected but both hepatic ducts were delineated on the second ERCP. Stents were placed into the right and left hepatic ducts. On PTD 71, a third ERCP revealed no contrast leakage; therefore, all stents were removed after 2 weeks (PTD 85). ERCP and biliary stenting could be effective treatment options for hemodynamically stable patients after blunt trauma.; Summary

Successful TAE after DCS for Active Arterial Bleeding from Blunt Hepatic Injury in a Child: A Case Report: Chan Ik Park, Sang Bong Lee, Kwang Hee Yeo, Seungchan Lee, Sung Jin Park, Ho Hyun Kim, Jae Hun Kim, Chang Won Kim, Chan Yong Park; J Trauma Inj. 2016;29(2):47-50. Published online June 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.2.47

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Abstract PDF

Transcatheter arterial embolization (TAE) for blunt hepatic injury in children is not common and is especially rare after damage control surgery (DCS). We report a successful TAE after DCS on a child for massive bleeding from the left hepatic artery due to a motor vehicle accident. The car (a sport utility vehicle) ran over the chest and abdomen of a 4-year-old boy. On arrival, initial vital signs were as follows: blood pressure, 70/40 mmHg; heart rate, 149/min; temperature, 36.7℃; respiratory rate, 38/min. After resuscitation, computed tomography was done, and a suspicious contrast leakage from a branch of the left hepatic artery and a spleen injury (grade V) were found. TAE was performed successfully after DCS for a liver injury.

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Damage Control Surgery for Abdominal Compartment Syndrome Caused by Delayed Rupture of Hepatic Subcapsular Hematoma
Chan Yong Park, Kwang Hee Yeo, Ho Hyun Kim, Seon Hee Kim, Hyun Min Cho, Hoon Kwon, Chang Ho Jeon, Chang Won Kim, Seok Ran Yeom
Trauma Image and Procedure.2017; 2(1): 17. CrossRef

External Iliac Artery Injury Caused by Abdominal Stab Wound: A Case Report: Sang Bong Lee, Jae Hun Kim, Chan Ik Park, Kwang Hee Yeo; J Trauma Inj. 2015;28(3):215-218. Published online September 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.3.215

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Abstract PDF: Traumatic iliac vessel injuries constitute approximately 25% of all abdominal vascular injuries. Hospital mortality has been reported at 25~60% and is a result of uncontrolled hemorrhage and hypovolemic shock caused by extensive blood loss. We report the case of a 25-year-old female patient who experienced an external iliac artery injury caused by abdominal minimal stab wound. Traumatic iliac vessel injuries are life-threatening complication of abdominal or pelvic injuries and prompt diagnosis and accurate treatment are important.; Summary

Penetrating Neck Trauma: A Case of Spinal Cord Injury by Embedded Scissor: Seon Hee Kim, Sun Woo Choi, Sung Jin Park, Kwang Hee Yeo, Chang Wan Kim, Sang Bong Lee, Ho Hyun Kim, Chan Yong Park, Jae Hun Kim, Jung Joo Hwang, Hyun Min Cho; J Trauma Inj. 2015;28(2):71-74. Published online June 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.2.71

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Abstract PDF: Penetrating neck trauma involving spinal cord injury is relatively uncommon, but can be life-threatening. We report a case of 59-year-old female who presented with hypotension after stab injury self-inflicted with a scissor to her neck. Although Open removal of the scissor and control of bleeding were successfully done, penetration of spinal cord resulted in a neurologic impairment.; Summary

Successful Angiographic Embolization of Superficial Circumflex Iliac Artery Rupture Caused by Blunt Abdominal Trauma: A Case Report: Sang Bong Lee, Sung Jin Park, Kwang Hee Yeo, Ho Hyun Kim, Chan Yong Park, Jae Hun Kim, Chang Wan Kim, Seon Uoo Choi, Seon Hee Kim, Jung Joo Hwang, Hyun Min Cho; J Trauma Inj. 2015;28(1):39-42. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.39

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Abstract PDF: Lat. abdominal wall hematoma with active bleeding is very rare but need prompt bleeding control. We report successful treatment by angiographic embolization of superficial circumflex iliac artery rupture caused by blunt trauma. A 60-year-old woman presented painful, enlarging, lat. abdominal wall mass with ecchymosis caused by blunt abdominal trauma. Contrast leakage of superficial circumflex iliac a. within the lt. ext. oblique m. hematoma was confirmed by abdominal computed tomography. Angiographic embolization was performed successfully. Patient was discharged at 4th day after trauma without complication. Angiographic embolization is important treatment option of lat. abdominal wall hematoma with active bleeding replacing emergency surgery.; Summary

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