- Analysis of Radiological and Clinical Results in Treatment of Open Segmented Tibia Fractures: A Comparison between Intramedullary Nailing and Minimal Invasive Plate Osteosynthesis
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Ji Wan Kim, Hyung Keun Song
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J Trauma Inj. 2016;29(3):76-81. Published online September 30, 2016
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DOI: https://doi.org/10.20408/jti.2016.29.3.76
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 Abstract
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- PURPOSE
The purpose of this study was to compare the data comprehensively including not only the clinical and radiographic outcomes but some parameters related to operation between the minimally invasive plate osteosynthesis (MIPO) technique and intramedullary nailing (IMN) for treatment of segmental tibia shaft fractures.
METHODS
We conducted a retrospective study of 31 patients (mean age, 49.3 years, range, 27-74 years), with a mean follow-up of 14.1 months (range, 12-19 months) with acute segmental tibial fractures (AO 42-C2) who underwent either surgical treatment of MIPO or IMN. In accordance with the Gustilo-Anderson classification, 11 were type I, 5 were type II, and 15 were type III. Initial compartment syndrome was confirmed in 2 cases.
RESULTS
There were no statistically significant differences in terms of the patient demographic data between the two groups. The time to definitive fixation was longer in the MIPO group (mean 13.7±10.9 days; range, 2-27) than in the intramedullary group (mean 5.4±9.6 days; range, 0-35) with statistically significant difference (p=0.002). Bony union was observed in most of cases but except 5 cases of nonunion were diagnosed (3 in the MIPO vs 2 in IMN, p=0.188). The average bone healing time was 27.1 weeks (10 to 56 weeks) in MIPO group and 23.2 weeks (13 to 66 weeks) in IMN group, respectively (p=0.056). Overall complications were 5 cases in MIPO group and 2 cases in the IMN group. Difference in LEFS was not statistically significant between both groups (p=0.824).
CONCLUSION
This study showed that segmental tibia shaft fractures treated with both MIPO and intramadullary nailing was challenging with relatively high complication rate. A well planned sequential strategy with keeping the soft tissue and personality of fracture in mind is utmost significant as much as the choice of surgical modalities.
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Summary
- Role of MRI in Deciding on a Treatment Plan for Sciatic Nerve Palsy after Reduction of a Hip Dislocation: Case Report
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Junho Cho, Woon Hyung Yeo, Ji Wan Kim
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J Trauma Inj. 2013;26(3):229-232.
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Abstract
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- Traumatic fracture-dislocations of the hip frequently result from high-energy injury, and hip dislocations are commonly associated with severe concomitant injuries. Sciatic nerve injury often accompanies traumatic fracture-dislocation of the hip, but neurologic examination at the time of injury is difficult in severely traumatized patients with decreased consciousness. We present such a case of multiple traumas with traumatic hip dislocation and sciatic nerve injury after reduction, and we found that magnetic resonance image (MRI) played an important role in developing a management plan.
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Summary
- Acalculous Cholecystitis Following Multiple Trauma with Fractures
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Ki Hoon Kim, Kyu Hyouk Kyung, Jin Su Kim, Kwan U Kim, Woon Won Kim, Ji Wan Kim
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J Trauma Inj. 2012;25(4):203-208.
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Abstract
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- PURPOSE
The purpose of this study is to investigate the incidence of acalculous cholecystitis after multiple trauma with fractures and to analyze the characteristics of cholecystitis.
METHODS
We performed a retrospective study of multiple trauma patients with fractures between April 2010 and April 2012. Sixty-nine patients were identified, and the average age was 46.8(range: 15-74) years. Data were collected regarding associated injury, injury severity score (ISS), the diagnosis time after trauma, diagnostic tool, and management.
RESULTS
There were three cases(4.3%) of cholecystitis among the 69 cases, and cholecystitis was diagnosed an average of 20.7(range: 8-33) days after injury. Two patients complained of abdominal pain at diagnosis, but the other patient who had undergone surgery for small bowel perforation at the time of the injury had no abdominal pain. All three patients had abnormal liver function tests (LFTs) at diagnosis. The cholecystitis was confirmed with ultrasonography or computed tomography, and all cases were acalculous cholecystitis. At first, percutaneous transhepatic gallbladder drainage was performed; then, laparoscopic cholecystectomy (LC) was tried an average of 12(range: 11-13) days later. An laparoscopic cholecystectomy was successfully done in only one case, the other cases being converted to an open cholecystectomy due to severe inflammation.
CONCLUSION
The incidence of acaculous cholecystitis was 4.3% after multiple trauma with fractures. We should consider cholecystitis in patients with abdominal pain, fever and elevated LFTs after multiple trauma.
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Summary
- The Importance of the Trauma Surgeon: A Reflection on the Management of Hemodynamically Unstable Pelvic Trauma Patients
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Sung Shin, Kyu Hyuk Kyung, Ji Wan Kim, Jung Jae Kim, Suk Kyung Hong
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J Korean Soc Traumatol. 2009;22(2):254-259.
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Abstract
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- PURPOSE
Pelvic trauma is a serious skeletal injury with high mortality. Especially in cases of severe injury trauma, treatment outcomes depend on early diagnosis and intervention. We expect trauma surgeon to play an important role in the management of severe multiple trauma patients.
METHODS
A retrospective study was performed on pelvic trauma patients with hemodynamic instability between March 2005 and September 2009. We divided the time period into period I (March 2005~Feburary 2009) and period II (March 2009~September 2009). The trauma surgeon and team started to work from period II. Data were collected regarding demographic characteristics, mechanism of injury, type of pelvic fracture, ISS (injury severity score), treatment modality, transfusion requirement, time to definitive treatment, and mortality.
RESULTS
During period I, among 7 hemodynamically unstable patients, 4(57.1%) patients died. However during Period II, only one of 6(16.6%) patients died. The demographic data and injury scores showed no differences between the two time periods, but the time to definitive treatment was very short with trauma team intervention( 14.4 hrs vs. 3.9 hrs). Also, the amount of transfusion was less(41.1 U vs. 13.9 U). With arterial embolization, early pelvic external fixation led to less transfusion and made patients more stable.
CONCLUSION
This study demonstrated the importance of the trauma surgeon and the trauma team in cases of hemodynamically unstable pelvic trauma. Even with the same facility and resources, an active trauma team approach can increase the survival of severely injured multiple trauma patients.
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