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Case Reports
Case reports of iatrogenic vascular injury in the trauma field: what is the same and what is different?
Youngwoong Kim, Kyunghak Choi, Seongho Choi, Min Ae Keum, Sungjeep Kim, Kyu-Hyouck Kyoung, Jihoon T Kim, Minsu Noh
J Trauma Inj. 2022;35(2):123-127.   Published online December 24, 2021
DOI: https://doi.org/10.20408/jti.2021.0088
  • 2,580 View
  • 80 Download
AbstractAbstract PDF
Iatrogenic vascular injury (IVI) can occur with any technique or type of surgery performed around a blood vessel. Patients with severe trauma are at risk of IVI. In this study, we describe our experiences of IVI in the trauma field. We reviewed five patients who were diagnosed with an IVI and received either surgical or endovascular treatment. Of the five patients, one had an arterial injury, three had venous injuries, and one had an arteriovenous fistula, a form of combined arterial and venous injuries. Of the five patients, four had undergone orthopedic surgery. The IVIs of three patients were immediately identified in the operating room and simultaneous vascular repair was performed. The remaining one patient underwent additional surgery for occlusion related to entrapment of the superficial femoral artery by a surgical wire used during orthopedic surgery. Complications presumably related to the IVI were identified in two patients. IVI in trauma patients can be successfully managed, but significant morbidity can occur. If an IVI is suspected, immediate evaluation and management are required.
Summary
A Carbon Monoxide Poisoning Case in Which Hyperbaric Oxygen Therapy Was Not Possible Due to Iatrogenic Pneumothorax after Unnecessary Central Catheterization
Hyung Il Kim, Seong Beom Oh
J Trauma Inj. 2019;32(4):252-257.   Published online December 30, 2019
DOI: https://doi.org/10.20408/jti.2019.040
  • 3,738 View
  • 48 Download
AbstractAbstract PDF

Hyperbaric oxygen therapy (HBOT) is used to treat carbon monoxide (CO) poisoning. However, untreated pneumothorax is an absolute contraindication for HBOT. More caution is needed with regard to monoplace hyperbaric chambers, as patient monitoring and life-saving procedures are impossible inside these chambers. Central catheterization is frequently used for various conditions, but unnecessary catheterization must be avoided because of the risk of infection and mechanical complications. Herein, we describe a case of CO poisoning in which iatrogenic pneumothorax developed after unnecessary subclavian central catheterization. The patient did not need to be catheterized, and HBOT could not be performed because of the pneumothorax. Hence, this case reminds us of basic—but nonetheless important—principles of catheterization.

Summary
Original Articles
Outcomes of Cranioplasty Using Autologous Bone or 3D-Customized Titanium Mesh Following Decompressive Craniectomy for Traumatic Brain Injury: Differences in Complications
Junwon Kim, Jang Hun Kim, Jong Hyun Kim, Taek-Hyun Kwon, Haewon Roh
J Trauma Inj. 2019;32(4):202-209.   Published online December 30, 2019
DOI: https://doi.org/10.20408/jti.2019.033
  • 5,385 View
  • 98 Download
  • 6 Citations
AbstractAbstract PDF
Purpose

Cranioplasty (CP) is often required for survival after decompressive craniectomy. Several materials, including autologous bone and various artificial materials, have been introduced for CP, but it remains unclear which material is best for CP. This study aimed to explore differences in complications between patients who underwent CP using an autologous bone flap versus a three-dimensional (3D) titanium mesh and to identify significant risk factors for post-CP complications.

 Methods

In total, 44 patients were enrolled in this study and divided into two groups (autologous bone vs. 3D titanium mesh). In both groups, various post-CP complications were evaluated. Through a comparative analysis, we aimed to identify differences in complications between the two groups and, using binary logistic analysis, to determine significant factors associated with complications after CP.

 Results

In the autologous bone flap group, there were three cases of surgical infection (3/24, 12.5%) and 11 cases of bone flap resorption (BFR) (11/24, 45.83%). In the 3D titanium mesh group, there was only one case of surgical infection (1/20, 5%) and 11 cases of various complications, including mainly cosmetic issues (11/20, 55%). A subgroup risk factor analysis of CP with an autologous bone flap showed no risk factors that predicted BFR with statistical significance, although a marginal association was found between larger bone flaps and BFR (odds ratio [OR]=1.037, p=0.090). In patients treated with a 3D titanium mesh, multivariate analysis revealed that only the existence of a ventriculo-peritoneal shunt system was strongly associated with overall post-CP complications (OR=18.66, p=0.021).

 Conclusions

Depending on which material was used, different complications could occur, and the rate of complications was relatively high in both groups. Hence, the material selected for CP should be selected based on individual patients’ conditions.

Summary

Citations

Citations to this article as recorded by  
  • Customized Additive Manufacturing in Bone Scaffolds—The Gateway to Precise Bone Defect Treatment
    Juncen Zhou, Carmine Wang See, Sai Sreenivasamurthy, Donghui Zhu
    Research.2023;[Epub]     CrossRef
  • Customized cost-effective polymethylmethacrylate cranioplasty: a cosmetic comparison with other low-cost methods of cranioplasty
    Manish Baldia, Mathew Joseph, Suryaprakash Sharma, Deva Kumar, Ashwin Retnam, Santosh Koshy, Reka Karuppusami
    Acta Neurochirurgica.2022; 164(3): 655.     CrossRef
  • Letter to the Editor: Complications following titanium cranioplasty compared with nontitanium implants cranioplasty: A systematic review and meta-analysis
    Michael Amoo, Jack Henry
    Journal of Clinical Neuroscience.2021; 87: 32.     CrossRef
  • Complications of Cranioplasty in Relation to Material: Systematic Review, Network Meta-Analysis and Meta-Regression
    Jack Henry, Michael Amoo, Joseph Taylor, David P O’Brien
    Neurosurgery.2021; 89(3): 383.     CrossRef
  • Comparison of complications in cranioplasty with various materials: a systematic review and meta-analysis
    Liming Liu, Shou-Tao Lu, Ai-Hua Liu, Wen-Bo Hou, Wen-Rui Cao, Chao Zhou, Yu-Xia Yin, Kun-Shan Yuan, Han-Jie Liu, Ming-Guang Zhang, Hai-Jun Zhang
    British Journal of Neurosurgery.2020; 34(4): 388.     CrossRef
  • A Reappraisal of the Necessity of a Ventriculoperitoneal Shunt After Decompressive Craniectomy in Traumatic Brain Injury
    Seunghan Yu, Hyuk Jin Choi, Jung Hwan Lee, Mahnjeong Ha, Byung Chul Kim
    Journal of Trauma and Injury.2020; 33(4): 236.     CrossRef
Cranioplasty Results after the Use of a Polyester Urethane Dural Substitute (Neuro-Patch®) as an Adhesion Prevention Material in Traumatic Decompressive Craniectomy
Tae Seok Jeong, Woo Kyung Kim, Myung Jin Jang
J Trauma Inj. 2019;32(4):195-201.   Published online December 30, 2019
DOI: https://doi.org/10.20408/jti.2019.030
  • 3,539 View
  • 84 Download
  • 1 Citations
AbstractAbstract PDF
Purpose

This study was conducted to investigate the usefulness of a polyester urethane dural substitute (Neuro-Patch®, B. Braun, Boulogne, France) as an anti-adhesion agent in subsequent cranioplasty by analyzing the use of Neuro-Patch® during decompressive craniectomy in traumatic brain injury patients.

 Methods

We retrospectively analyzed patients with traumatic brain injury who underwent decompressive craniectomy followed by cranioplasty from January 2015 to December 2018. Patients were analyzed according to whether they received treatment with Neuro-Patch® or not (Neuro-Patch® group, n=71; control group, n=55). Patients’ baseline characteristics were analyzed to identify factors that could affect cranioplasty results, including age, sex, hypertension, diabetes mellitus, use of antiplatelet agents or anticoagulant medication, the interval between craniectomy and cranioplasty, and the type of bone used in cranioplasty. The cranioplasty results were analyzed according to the following factors: operation time, blood loss, postoperative hospitalization period, surgical site infection, and revision surgery due to extra-axial hematoma.

 Results

No significant difference was found between the two groups regarding patients’ baseline characteristics. For the cranioplasty procedures, the operation time (155 vs. 190 minutes, p=0.003), intraoperative blood loss (350 vs. 450 mL, p=0.012), and number of surgical site infections (4 vs. 11 cases, p=0.024) were significantly lower in the Neuro-Patch® group than in the control group.

 Conclusions

The use of Neuro-Patch® was associated with a shorter operation time, less blood loss, and a lower number of surgical site infections in subsequent cranioplasties. These results may provide a rationale for prospective studies investigating the efficacy of Neuro-Patch®.

Summary

Citations

Citations to this article as recorded by  
  • Efficacy and safety of decompressive craniectomy with non-suture duraplasty in patients with traumatic brain injury
    Tae Seok Jeong, Gi Taek Yee, Tae Gyu Lim, Woo Kyung Kim, Chan Jong Yoo, Giovanni Grasso
    PLOS ONE.2020; 15(10): e0232561.     CrossRef
The Consequence of Delayed Diagnosis of an Occult Hip Fracture
Sangbong Je, Hyejin Kim, Seokyong Ryu, Sukjin Cho, Sungchan Oh, Taekyung Kang, Seungwoon Choi
J Trauma Inj. 2015;28(3):91-97.   Published online September 30, 2015
DOI: https://doi.org/10.20408/jti.2015.28.3.91
  • 6,563 View
  • 65 Download
  • 4 Citations
AbstractAbstract PDF
PURPOSE
Occult hip fracture is not evident on radiographs and the diagnosis is often missed or delayed. This study was undertaken in order to identify the clinical characteristics and complications of patients with a delayed diagnosis of an occult hip fracture.
METHODS
We retrospectively reviewed patients with occult hip fracture who had normal findings on initial radiographs, the diagnosis was made on additional studies between August 2006 and February 2012. Patients who were diagnosed as having occult hip fractures at the first visit were categorized as non-delayed group and those who were not diagnosed at the first visit were categorized as delayed group.
RESULTS
Non-delayed group included 43 patients (86%). In the remaining 7 patients (delayed group), the diagnosis was delayed by a mean of 9.6 days (range 3~19 days). Patients who were diagnosed with an occult fracture on the initial visit presented later than those with a delayed diagnosis (41/43 .vs. 3/7, p=0.002). Other clinical features were no difference between the two groups. Patients in the delayed diagnosis group were more likely to have fracture displacement (4/7 .vs. 0/43)15patients in non-delayed group (34.9%) needed operative treatment, whereas all delayed patients (100%) needed operative treatment.
CONCLUSION
A delayed diagnosis of occult hip fractures was associated with increased rate of displacement and operation. In patients suspected of having occult hip fractures, additional studies should be recommended.
Summary

Citations

Citations to this article as recorded by  
  • APPLICATION OF ARTIFICIAL INTELLIGENCE TO ASSIST HIP FRACTURE DIAGNOSIS USING PLAIN RADIOGRAPHS
    Phichai Udombuathong, Ruthasiri Srisawasdi, Waravut Kesornsukhon, San Ratanasanya
    Journal of Southeast Asian Medical Research.2022; 6: e0111.     CrossRef
  • Differential diagnosis of acute traumatic hip pain in the elderly
    Matthew Hampton, Richard Stevens, Adrian Highland, Richard Gibson, Mark B Davies
    Acta Orthopaedica Belgica.2021; 87(1): 1.     CrossRef
  • The Necessity of CT Hip Scans in the Investigation of Occult Hip Fractures and Their Effect on Patient Management
    Thomas Gatt, Daniel Cutajar, Lara Borg, Ryan Giordmaina, Panagiotis Korovessis
    Advances in Orthopedics.2021; 2021: 1.     CrossRef
  • Clinical characteristics and short to mid term functional outcomes of surgically treated occult hip fractures in the elderly
    Sean W.L. Ho, Lynn Thwin, Ernest B.K. Kwek
    Injury.2018; 49(12): 2216.     CrossRef
Complications of a Tube Thoracostomy Performed by Emergency Medicine Residents
Dai Yun Cho, Dong Suep Sohn, Young Jin Cheon, Kihun Hong
J Korean Soc Traumatol. 2012;25(2):37-43.
  • 1,155 View
  • 6 Download
AbstractAbstract PDF
PURPOSE
A tube thoracostomy is an invasive procedure that places patients at risk for complications. Tube thoracostomies are frequently performed by emergency medicine residents. Thus, the purpose of the study was to assess both the complication rate for tube thoracostomies performed by emergency medicine residents and the factors associated with these complications.
METHODS
A retrospective chart review of all patients who had undergone a tube thoracostomy performed by emergency medicine residents between January 2008 and February 2009 was conducted at a university hospital. Complications were divided into major and minor complications and into immediate and delayed complications. Complications requiring corrective surgical intervention, requiring the administration of blood products, or involving situations requiring intravenous antibiotics were defined as major. Complications that were detected within 2 hours were defined as immediate.
RESULTS
Tube thoracostomies were performed in 189 patients, and 70 patients(37%) experienced some complications. Most complications were immediate and minor. In multiple logistic regressions, BMI, hypotension and resident seniority were significantly associated with complications.
CONCLUSION
The prevalence of complications was similar to these in previous reports on the complications of a tube thoracostomy. Most complications from tube thoracostomies performed by emergency medicine residents were immediate and minor complications. Thus, emergency medicine residents should be allowed to perform closed tube thoracostomies instead of thoracic surgeons.
Summary
Severe Traumatic Intraocular Injuries Related to Blowout Fractures
Jae Hoon Shin, Mi Jin Lee, Seong Soo Park, Won Joon Jeong, Yeon Ho You
J Korean Soc Traumatol. 2009;22(1):97-102.
  • 1,150 View
  • 2 Download
AbstractAbstract PDF
PURPOSE
Blunt trauma can cause a wide range of ocular injuries. This study was performed to describe the prevalence of severe intraocular injuries (SIOI) and their correlation with the severity of blunt orbital trauma.
METHODS
We retrospectively analyzed 117 eyes of 107 patients with orbital wall fractures who visited the emergency room at Konyang University Hospital from July 2006 to June 2008. Clinical features such as age, sex, causes of injury, revised trauma score (RTS), type of orbital wall fractures were recorded. The patients were divided into two groups: blowout fracture with severe intraocular injuries (SIOI) and blowout fracture without SIOI. We compared the clinical and the injury-related characteristics between two groups and analyzed the SIOS-related factors.
RESULTS
Among the 107 patients (117 eyes) with blowout fractures, 29 (27.1%) patients with 32 eyes (25.6%) had complicated severe intraocular injuries. Retrobulbar hemorrhage (14.5%), hyphema (13.7%), traumatic optic nerve injury (4.3%), and sustained loss of visual acuity (4.3%) were the most common SIOI disorders. A logistic regression analysis revealed that loss of visual acuity (odds ratio = 4.75) and eyeball motility disorder (odds ratio=7.61) were significantly associated with SIOS.
CONCLUSION
We suggest that blowout fracture patients with loss of visual acuity or eyeball motility disorder are mostly likely to have severe intraocular injuries, so they need an ophthalmologic evaluation immediately.
Summary
Car-tire-related Crushing Injury of the Lower Leg in Children
Jaeyeon Choi, Jaeho Jang, Jaehyuck Woo, Wonbin Park, Jinjoo Kim, Sungyeol Hyun, Geun Lee, Jeehoon Gwak
J Trauma Inj. 2013;26(3):175-182.
  • 1,190 View
  • 4 Download
AbstractAbstract PDF
PURPOSE
Crushing injuries by car tires result from a combination of friction, shearing, and compression forces and the severity of injury is influenced by the acceleration. Because car-tire injuries of the lower leg in children are common these days but they have received little attention; thus, our purpose was to look closely into this problem.
METHODS
A retrospective analysis was conducted of data from children under 15 years old age who visited an emergency department because of a car-tire-related crushing injury to the lower leg in pedestrian traffic accident from January 2008 to September 2012. The patient's age, sex, site of injury, degree of injury, associated injuries, type of surgery, and complications were reviewed.
RESULTS
There were 39 children, the mean age was 8.0 years, and 71.8% were boys. The dorsal part of the leg was involved most frequently. According to the severity classification, 15 children were grade I, 6 were grade II, and 18 were grade III. Among 24 patients, 13 were treated with skin graft and 3 were treated using a sural flap. Twelve patients developed complications, such as hypertrophic scarring, contractures, and deformities with significant bone loss.
CONCLUSION
Various degrees of skin or soft tissue defects were caused in children by car tires. In this study, patients were often also had tendon or bone damage. Proper and timely initial treatments are needed to reduce the incidence of infection, the number of operative procedures, and the hospital stay.
Summary
J Trauma Inj : Journal of Trauma and Injury
© The Korean Society of Traumatology.