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Original Article
- Vitamin D levels and bone mineral density: a prospective cross-sectional analysis of young orthopedic trauma patients at a rural United States trauma center
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Michael Booth, Kenneth Sabacinski, Colleen Watkins, Erin Butcho, Emilie Kramer, Lukas Meadows, Michelle A. Bramer
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J Trauma Inj. 2024;37(4):276-280. Published online December 26, 2024
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DOI: https://doi.org/10.20408/jti.2024.0038
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Abstract
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- Purpose
The goal of this cross-sectional study was to investigate the prevalence of vitamin D deficiency in young orthopedic trauma patients and its impact on bone mineral density (BMD) measured through computed tomography imaging of the lumbar spine.
Methods
Conducted at a level I trauma center, this prospective cross-sectional analysis included 100 patients aged 18 to 50 years with non-fragility fractures. Vitamin D levels and Hounsfield units of the lumbar spine were recorded from computed tomography scans. Exclusion criteria included fragility fractures, lumbar surgery history, or lumbar bony/metastatic lesions. The correlation between vitamin D levels and BMD was assessed; vitamin D deficiency was defined as below 30 ng/mL.
Results
Among the participants, 75% were vitamin D–deficient, with an average vitamin D level of 25.0 ng/mL. No patients had osteoporosis based on Hounsfield units; however, 5% of patients were in the osteopenic range. In patients with normal vitamin D levels, there was an inverse correlation between vitamin D levels and BMD measured by Hounsfield units (P=0.025). Higher lumbar spine Hounsfield unit measurements correlated with lower vitamin D levels in this nondeficient population.
Conclusions
This study highlights a high prevalence of vitamin D deficiency in young orthopedic trauma patients, and it suggests a potential inverse relationship with BMD in patients with vitamin D levels >30 ng/mL. The absence of osteoporosis in our population raises questions about the influence of vitamin D on BMD in this young trauma patient demographic. Future research should explore the impact of vitamin D replacement on fracture union and investigate the interaction between vitamin D levels and bone health in the younger orthopedic trauma population.
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Summary
Erratum
- Erratum to “Massive traumatic abdominal wall hernia in pediatric multitrauma in Australia: a case report”
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J Trauma Inj. 2024;37(4):309-309. Published online December 26, 2024
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DOI: https://doi.org/10.20408/jti.2023.0023.e
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Corrects: J Trauma Inj 2023;36(4):447
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Summary
Case Report
- Liver laceration as a post-cardiopulmonary resuscitation complication in a person with breast implants: a case report
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Min-Jeong Cho
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J Trauma Inj. 2024;37(4):300-303. Published online December 16, 2024
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DOI: https://doi.org/10.20408/jti.2024.0077
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Abstract
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- Cardiac compression is the most crucial component of successful cardiopulmonary resuscitation (CPR). However, CPR procedure poses a risk of complications, even when CPR providers perform cardiac compressions as recommended. Reports indicate that solid organ injuries, including liver injuries, occur with an incidence of about 0.6% to 3%. In this particular case, a 25-year-old woman was found hanged in her apartment. She was transported to a nearby hospital where CPR was administered for approximately 30 minutes until she was resuscitated. Subsequently, an abdomen-pelvis computed tomography scan revealed a liver injury. The location of the liver injury, between the sternum and spine, suggested it was a compression injury caused by CPR. There was no evidence of extravasation or active bleeding; thus, conservative management was chosen for the liver injury. By hospital day 4, the patient's pupil reflex had completely disappeared. Electroencephalography showed generalized attenuation, indicating severe global brain damage. Liver injury is a relatively rare post-CPR complication, with an incidence of 0.6% according to a retrospective analysis of a cardiac arrest registry. The liver is partially situated between the sternum and spine. The end of the sternum is shaped like an inverted triangle, resembling a sword. Therefore, if the CPR provider's hands are placed too low or excessive pressure is applied, the sternum can injure the left liver. Blood loss from liver injuries could potentially hinder the successful resuscitation of patients. In this case, had there been no blood loss from the liver injury, the patient might have maintained better cerebral perfusion and function.
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Summary
Original Article
- Management of cardiac trauma and penetrating cardiac injuries with severe hemorrhagic shock: a 5-year experience
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Tran Thuc Khang
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J Trauma Inj. 2024;37(4):268-275. Published online December 16, 2024
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DOI: https://doi.org/10.20408/jti.2024.0063
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Abstract
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- Purpose
The diagnosis and management of cardiac trauma and penetrating cardiac injuries pose significant challenges in emergency settings due to the rapid onset of life-threatening complications. This paper presents a narrative review to better describe the etiology, presentation, and management of penetrating cardiac trauma, offering insights and experiences related to performing emergency surgery for such cases.
Methods
We compiled cases of traumatic cardiac rupture and penetrating cardiac injuries accompanied by severe hemorrhagic shock that necessitated emergency surgery. Data were collected regarding the type of injury, causative agents, specific clinical features observed during emergency admission, intraoperative parameters, and treatment outcomes.
Results
Twenty-one patients (16 men, 5 women) with cardiac rupture or penetrating cardiac injuries were recorded. All patients presented in severe shock, and six cases (28.6%) experienced cardiac arrest upon arrival in the operating room. Cardiac rupture due to blunt chest trauma occurred in two cases (9.5%), and one case (4.8%) involved right atrial perforation due to complex open chest trauma. Penetrating injuries accounted for cardiac perforation in 18 cases (85.7%). Associated injuries were present in 11 cases (52.4%). The intraoperative mortality rate was 9.5%, and there was one postoperative death on the 11th day due to multiorgan failure.
Conclusions
Cardiac trauma and penetrating injuries are usually fatal unless promptly diagnosed and surgically treated. The timing and rapidity of emergency surgery—often foregoing ancillary tests and administrative procedures—are critical for patient survival. Emergency sternotomy, swift control of bleeding, and aggressive resuscitation are essential operative measures in saving lives. Factors that influence prognosis include the extent of blood loss, duration of cardiac arrest, acid-base imbalances, coagulopathy, multiorgan failure, and postoperative infections.
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Summary
Review Article
- Splenic artery embolization for trauma: a narrative review
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Simon Roh
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J Trauma Inj. 2024;37(4):252-261. Published online December 16, 2024
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DOI: https://doi.org/10.20408/jti.2024.0056
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- The management of traumatic splenic injuries has evolved significantly over the past several decades, with the majority of these injuries now being treated nonoperatively. Patients who exhibit hemodynamic instability upon initial evaluation typically require surgical intervention, while the remainder are managed conservatively. Conservative treatment for traumatic splenic injuries encompasses both medical management and splenic artery angiography, followed by embolization in cases where patients exhibit clinical signs of ongoing splenic hemorrhage. Splenic artery embolization is generally divided into two categories: proximal and distal embolization. The choice of embolization technique is determined by the severity and location of the splenic injury. Patients who retain functioning splenic tissue after trauma do not routinely need immunization. This is in contrast to post-splenectomy patients, who are at increased risk for opportunistic infections.
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Summary
Case Reports
- Delayed and recurrent surgical site infection from resorbed bone fragment after autologous cranioplasty: a case report
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Jin Hoo Seok, Hae Won Roh, Jong Hyun Kim
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J Trauma Inj. 2024;37(4):304-308. Published online December 16, 2024
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DOI: https://doi.org/10.20408/jti.2024.0052
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- Decompressive craniectomy is one of the most common procedures for managing severe traumatic brain injury. Cranioplasty plays a vital role in restoring the integrity of the skull and preventing complications that may arise after a decompressive craniectomy. This case report presents a 24-year-old woman who underwent cranioplasty with a cryopreserved autologous bone flap. Initially successful, the procedure was later complicated by a delayed surgical site infection and methicillin-resistant Staphylococcus aureus osteomyelitis, ultimately resulting in complete resorption of the bone flap. The report discusses the consequences of autologous bone flap resorption and surgical site infection, highlighting the critical need for effective sterilization and proper bone storage techniques. This case emphasizes the necessity of exploring alternative strategies to improve cranioplasty outcomes and minimize the risk of infection.
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Summary
- Minimally invasive surgery for concomitant pericardial and diaphragmatic rupture after blunt trauma: a case report
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Ranti Kenny Maila, Kenny Nyiko Mongwe, Mirza Mohamod Zahir Uddin Bhuiyan
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Received July 9, 2024 Accepted October 1, 2024 Published online December 16, 2024
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DOI: https://doi.org/10.20408/jti.2024.0045
[Epub ahead of print]
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Abstract
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- Pericardial rupture with cardiac herniation is a rare injury that occurs following blunt trauma. It is even more unusual to find a pericardial tear associated with diaphragmatic injury after such trauma. Diagnosing this condition through radiologic imaging is challenging. A 51-year-old man was admitted to the emergency department after a wall collapsed on him. He reported overall body discomfort, breathlessness, chest pain, and abdominal discomfort. A plain x-ray revealed haziness in the left thoracic cavity and elevation of the left hemidiaphragm with collapse of the left lung. Additionally, a gastric shadow was seen within the left hemithorax, accompanied by a mediastinal shift to the right. An x-ray of the pelvis displayed fractures at the right sacroiliac joint, left superior pubic ramus, left inferior pubic ramus, and left anterior acetabular with displacement. A computed tomography scan indicated herniation of the stomach, splenic flexure, and spleen, but there was no clear evidence of pericardial laceration. The patient underwent emergency exploratory laparoscopy and thoracoscopy. During the laparoscopy, a significant defect was found in the left hemidiaphragm, along with a pericardial rupture that had led to cardiac herniation and visceral herniation of the stomach, splenic flexure, and spleen through the diaphragmatic tear. The abdominal visceral organs were repositioned into the abdomen, and the diaphragm was repaired. The heart was repositioned, and the pericardial defect was closed using thoracoscopic techniques. Pericardial rupture can be effectively managed using minimally invasive surgery.
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Summary
- Reperfusion injury or cytokine storm? Utilizing plasmapheresis in severe trauma-induced multiorgan failure: a case report
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Gun Woo Kim, Suyeong Hwang, Kyoung Hoon Lim, Sung Hoon Cho
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J Trauma Inj. 2024;37(4):295-299. Published online December 4, 2024
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DOI: https://doi.org/10.20408/jti.2024.0051
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- Reperfusion injury can cause tissue damage due to ischemia, with severe cases potentially resulting in multiorgan failure. Cytokine storm, a life-threatening systemic inflammatory state characterized by elevated levels of circulating cytokines and hyperactive immune cells, can also lead to tissue damage and multiorgan failure. Reperfusion injury and cytokine storm sometimes exhibit similar clinical features, necessitating specific treatment in severe cases. A 31-year-old man sustained a stab wound to his left knee. Computed tomography angiography and surgical exploration revealed a transection of the left popliteal artery and vein. Both vessels were revascularized via end-to-end anastomosis approximately 3 hours after the injury. On postoperative day 2, marked increases were observed in levels of aspartate aminotransferase (8,600 U/L), alanine transaminase (6,690 U/L), creatine phosphokinase (26,817 U/L), and lactate dehydrogenase (7,398 U/L) levels. Elevated levels of interleukin 6 (178 pg/mL) and ferritin (41,079 ng/mL) were also noted. Given the possibility of either reperfusion injury or cytokine storm, plasmapheresis was initiated. Following two rounds of plasmapheresis, the patient’s condition rapidly improved, and he was discharged without complications. Reperfusion injury can arise when a target blood vessel is revascularized, particularly during severe stages of ischemia. Cytokine storm represents a life-threatening systemic inflammatory state characterized by high levels of circulating cytokines and overactive immune cells. Both reperfusion injury and cytokine storm can cause systemic inflammation and multiorgan failure. These two conditions may exhibit similar clinical features, necessitating supportive care primarily to prevent organ dysfunction. However, plasmapheresis may represent an effective treatment option in cases of severe progression.
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Summary
- Treatment of placental abruption following blunt abdominal trauma: a case report
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Jinjoo Kim, Seokyung Kim, Dongwook Kwak, Donghwan Choi
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Received July 23, 2024 Accepted October 7, 2024 Published online December 4, 2024
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DOI: https://doi.org/10.20408/jti.2024.0050
[Epub ahead of print]
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Abstract
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- Trauma during pregnancy poses a potentially tragic risk to both the fetus and mother, making its management particularly challenging. Here, we present the case of a 35-year-old woman at 34 weeks and 2 days gestation who was in a motor vehicle accident and subsequently suffered placental abruption and underwent an emergency cesarean section. We also present a review of traumatic placental abruption and its epidemiology. On arrival at the trauma bay, the patient showed no significant abdominal findings other than a seat belt sign. However, 2 hours after admission, the patient developed abdominal pain and vaginal bleeding. Ultrasonography revealed no clear evidence of placental abruption. This case demonstrates the necessity of close maternal and fetal monitoring with cooperation between the trauma and obstetric teams. Even in the absence of typical symptoms such as abdominal pain on initial presentation, a high-energy mechanism of injury should be suspected.
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Summary
Original Article
- Injuries from blank cartridge shots in suicide attempts within the South Korean military: a case series of five patients
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Jeong Il Joo, Changsin Lee, Kyungwon Lee
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J Trauma Inj. 2024;37(4):262-267. Published online December 4, 2024
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DOI: https://doi.org/10.20408/jti.2024.0037
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Abstract
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- Purpose
Blank cartridges are designed to produce the sound and gas flare of a gunshot without firing a bullet. However, blank cartridge shots (BCS) can still cause injuries ranging from minor to life-threatening. Within the South Korean military, most BCS-related injuries have occurred during suicide attempts. This study documents a case series of patients who sustained injuries from BCS during such attempts.
Methods
We examined the medical records of Korean soldiers at a military trauma center between April 2022 and April 2024 who had sustained injuries from BCS during suicide attempts. The analyzed data included general characteristics, injury site, surgical and psychiatric interventions, and length of hospitalization.
Results
The case series included five patients between 19 and 20 years old (mean age, 19.6±0.55 years). Four of these patients sustained self-inflicted gunshot wounds to the submandibular area, while one targeted the right temporal area. Although initial vital signs and laboratory findings were unremarkable, computed tomography scans revealed injuries from projectile gas and gunpowder, including burns, subcutaneous emphysema, and major structural damage. Cases 1 and 2 required emergency surgery for foreign body removal and debridement. The average length of hospitalization was 35.2±12.11 days. Patients were first admitted to the trauma surgery department for BCS injury management, and then transferred to the psychiatry department for emotional support. The average stay was 15.6±15.87 days in trauma surgery and 19.6±14.99 days in psychiatry.
Conclusions
This study highlights the consequences of BCS from suicide attempts in the South Korean military and provides valuable insights for medical personnel who may encounter patients with BCS injuries.
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Summary
Case Reports
- Heterodigital flap as a solution for a thumb defect: a case report
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Bontor Daniel Sinaga, Dwi Purnomo Setyo Budi, Mochamad Sadabaskara
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Received July 19, 2024 Accepted October 1, 2024 Published online November 18, 2024
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DOI: https://doi.org/10.20408/jti.2024.0049
[Epub ahead of print]
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- Thumb traumatic injuries are incredibly common in hand injuries. The thumb is essential to hand function in order to do daily tasks like gripping, holding, opposing, circumducting, and movements. As a result, compared to injuries to other fingers, a thumb injury significantly impairs hand function. Traumas can cause soft tissue loss linked to vascular injuries that require revascularization. Replantation is the surgical treatment most frequently suggested to patients who have had their thumbs amputated in an attempt to restore function and attractiveness. There are alternative reconstructive techniques, such as skin grafting or local, distal, and free flaps, when replantation of the severed segment is not feasible. Reconstruction techniques vary depending on where the amputation occurred and include transfer site reconstruction and homodigital and heterodigital flaps. We reported a case of a woman who has a right traumatic thumb injury due to blender accident. Primary suturing and debridement were done to save the thumb. But after several days, the thumb was necrotic and not viable. Heterodigital island flap from the right middle finger was chosen. Radial forearm skin was grafted to cover the middle finger defect. This gave satisfactory results. Wound healing was quite good, but there were signs of scar tissue growth after several months of follow-up. The function and mobility of the thumb and hand were also achieved well through the QuickDASH (quick Disability of the Arm, Shoulder and Hand) score. Heterodigital flap provides satisfactory results both aesthetically and functionally in traumatic thumb injury cases.
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Summary
- Differentiation of antimicrobial toxicity and sepsis-induced disseminated intravascular coagulation in an orthopedic burn patient in India: a case report
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Parampreet Singh Saini, Ankita Aggarwal, Tarunpreet Saini
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Received June 27, 2024 Accepted September 19, 2024 Published online November 18, 2024
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DOI: https://doi.org/10.20408/jti.2024.0040
[Epub ahead of print]
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- Drug-induced thrombocytopenia, hemolytic anemia, and leukopenia are serious, and sometimes fatal, complications of common medications. These conditions are challenging to diagnose in patients with polytrauma injuries due to the presence of multiple potential etiologies. In such clinical scenarios, sepsis-induced disseminated intravascular coagulation is a more frequent diagnosis. The clinical manifestations of these conditions can be indistinguishable. We present the case of a 32-year-old man who sustained a left open grade 2 leg fracture and 18% to 20% second-degree superficial electrical flash burns on his right leg. Following primary management, skin testing for antibiotic sensitivity was performed, and prophylactic therapy with ceftriaxone, gentamycin, and metronidazole was initiated for the grossly contaminated wounds. On the second day of emergency admission, the patient developed hepatorenal dysfunction accompanied by severe thrombocytopenia (<30×103/mm3). The suspected antimicrobial agents were discontinued by the third day. Within 48 hours, the patient’s hepatorenal function markedly improved; however, the blood dyscrasia progressed to severe pancytopenia over the next few days. Despite worsening parameters, the patient’s vitals were maintained, and he exhibited no overt bleeding. On the fourth day, the patient developed opportunistic fungal bronchopneumonia, indicated by bilateral lower lobe infiltrates on chest x-ray and an elevated serum galactomannan level. He received supportive care, broad-spectrum antibiotics, and antifungal treatment, with a full recovery within 2 weeks. Antibiotic toxicity must be distinguished from other medical conditions to ensure appropriate management and a favorable prognosis.
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Summary
- Acute irreducible anterior shoulder dislocation due to interposition of the subscapularis muscle and the lesser tuberosity: a case report
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Nazim Sifi, Ahmad Madani, Mahdi Zeghdoud
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Received July 7, 2024 Accepted August 29, 2024 Published online October 21, 2024
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DOI: https://doi.org/10.20408/jti.2024.0044
[Epub ahead of print]
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Abstract
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- Efforts to reduce an anterior shoulder dislocation can fail due to numerous mechanical obstructions caused by soft tissue interposition (long head of the biceps, rotator cuff muscles, labrum, musculocutaneous nerve) and/or bony elements (displaced fragment of a greater tuberosity or glenoid fracture, bone impaction such as a Hill-Sachs lesion fixed on the glenoid rim, a bony Bankart lesion). Herein, we report the case of a 35-year-old man who sustained an anterior shoulder fracture-dislocation of his left shoulder after a fall. Despite a postreduction radiological examination that appeared misleadingly reassuring, subtle signs of persistent subluxation raised concerns. A computed tomography (CT) scan revealed subscapularis muscle entrapment along with avulsion of its bony insertion from the lesser tuberosity of the humerus, and a comminuted avulsion fracture of the greater tuberosity of the humerus. The patient underwent surgery using a deltopectoral approach. This involved releasing the entrapped subscapularis muscle and fixing the two fractured fragments. The lesser tuberosity was reduced and secured with two cannulated screws, and the comminuted fragment of the greater tuberosity was reattached using transosseous sutures. At 12-month follow-up, the patient achieved a Constant-Murley score of 85 of 100, with limitation in internal rotation at L3 but no signs of instability or new dislocation episode. This case underscores the importance of confirming shoulder reduction on at least two orthogonal views and paying close attention to the patient’s feedback about sensation in their shoulder. Additionally, it highlights the utility of CT or magnetic resonance imaging scans if doubt exists about the integrity of the reduction.
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Summary
- A starry night: a case report of severe liver injury due to a close-range shotgun blast in Argentina
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Rodrigo Antonio Gasque, José Gabriel Cervantes, Magalí Chahdi Beltrame, Marcelo Enrique Lenz-Virreira, Emilio Gastón Quiñonez
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J Trauma Inj. 2024;37(4):286-290. Published online October 21, 2024
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DOI: https://doi.org/10.20408/jti.2024.0036
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- This report presents the case of a 20-year-old man who sustained a severe liver injury from a close-range shotgun blast. A prompt medical intervention, including damage control exploratory laparotomy and surgical debridement, was undertaken due to the extent of liver damage. Despite challenges such as a nondirected biliary fistula and extensive liver parenchymal injury, comprehensive surgical management led to successful treatment. Postoperative complications, including biloma and fungal infection, were managed appropriately, highlighting the importance of vigilant follow-up care. The case underscores the complexity of managing severe liver trauma and emphasizes the evolving role of trauma damage control strategies and minimally invasive procedures in achieving favorable outcomes.
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Summary
- Purtscher retinopathy following isolated chest compression: a case report
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Min Uk Jang, Ho Gil Jung, Youngwoong Kim
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J Trauma Inj. 2024;37(4):291-294. Published online October 21, 2024
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DOI: https://doi.org/10.20408/jti.2024.0032
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- This case report describes the case of a 56-year-old man who developed Purtscher retinopathy following compressive chest trauma. During the tertiary survey, the patient was found to have a unilateral partial vision decline despite sustaining only mild rib fractures. The patient was diagnosed with a rare complication of Purtscher retinopathy. At a 2-week follow-up outpatient examination, improved visual acuity was observed. This case highlights the importance of conducting a tertiary survey not only on the directly impacted site, but also comprehensively across all sites, while attentively listening to and addressing the patient’s complaints.
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Summary
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