Journal of Trauma and Injury

Original Article

Could the Injury Severity Score be a new indicator for surgical treatment in patients with traumatic splenic injury?: HyeJeong Jeong, SungWon Jung, Tae Gil Heo, Pyong Wha Choi, Jae Il Kim, Sung Min Jung, Heungman Jun, Yong Chan Shin, Eunhae Um; J Trauma Inj. 2022;35(3):189-194. Published online May 30, 2022; DOI: https://doi.org/10.20408/jti.2021.0065

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Abstract PDF Supplementary Material: Purpose
The purpose of this study was to determine whether a higher Injury Severity Score (ISS) could serve as an indicator of splenectomy in patients with traumatic splenic lacerations.
Methods
A total of 256 cases of splenic laceration were collected from January 1, 2005 to December 31, 2018. After the application of exclusion criteria, 105 were eligible for this study. Charts were reviewed for demographic characteristics, initial vital signs upon presentation to the emergency room, Glasgow Coma Scale, computed tomography findings, ISS, and treatment strategies. The cases were then divided into nonsplenectomy and splenectomy groups for analysis.
Results
When analyzed with the chi-square test and t-test, splenectomy was associated with a systolic blood pressure lower than 90 mmHg, a Glasgow Coma Scale score lower than 13, active bleeding found on computed tomography, a splenic laceration grade greater than or equal to 4, and an ISS greater than 15 at presentation. However, in multivariate logistic regression analysis, only active bleeding on computed tomography showed a statistically significant relationship (P=0.014).
Conclusions
Although ISS failed to show a statistically significant independent relationship with splenectomy, it may still play a supplementary role in traumatic splenic injury management.; Summary

Case Reports

Endovascular treatment of penetrating nail gun injury of the cervical spine and vertebral artery: a case report: Alexei Christodoulides, Scott Mitchell, Bradley N. Bohnstedt; J Trauma Inj. 2022;35(3):223-227. Published online May 26, 2022; DOI: https://doi.org/10.20408/jti.2021.0082

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Abstract PDF: In this report, we present a case of high cervical penetrating trauma with vertebral artery injury and outline preprocedural, procedural, and postprocedural considerations with recommendations for the treatment of similar injuries. Management involves multiple imaging modalities, including X-ray imaging, computed tomography, computed tomography angiography, magnetic resonance imaging, and catheter angiography. We recommend endovascular treatment of these injuries when possible, based on the improved ability to achieve proximal and distal control and manage hemorrhage risk.; Summary

A case report of complete cricotracheal separation: an experience from the east coast of Malaysia: Atikah Rozhan, Adam Mohamad, Khairul Azhar M. Rajet, Mohd Zaki Ahmad, Suhaimi Bin Yusof, Wan Emelda Wan Mohamed, Bathma Devi Susibalan, Nik Mohd Syukra Nik Abd Ghani, Zamzil Amin Bin Asha’ari; J Trauma Inj. 2022;35(4):282-286. Published online May 26, 2022; DOI: https://doi.org/10.20408/jti.2021.0071

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Abstract PDF: Complete cricotracheal separation, which is the most severe type of laryngeal trauma, is an uncommonly seen injury that clinicians have limited experience in managing. However, it is potentially fatal. Due to limited exposure to this condition, mismanagement can occur, which may further aggravate the patient’s condition. The most crucial part of managing this injury is to establish a secure airway. Tracheostomy under local anesthesia is the preferred method of airway stabilization, in order to avoid further injuries to the airway caused by endotracheal intubation. Here, we discuss the management of complete cricotracheal separation based on a case experienced in the east coast region of Malaysia, where this type of injury is rarely encountered.; Summary

Hyperbaric oxygen therapy for the treatment of a crush injury of the hand: a case report: Pedro Henry Neto, Zamara Brandão Ribeiro, Adriano Bastos Pinho, Carlos Henrique Rodrigues de Almeida, Carlos Alberto de Albuquerque Maranhão, Joaquim da Cunha Campos Goncalves; J Trauma Inj. 2022;35(3):209-214. Published online May 26, 2022; DOI: https://doi.org/10.20408/jti.2021.0048

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Abstract PDF: We describe a case of hyperbaric oxygen therapy (HBOt) as an adjunct to treatment of a crush injury to the hand. A 34-year-old male paramedic was involved in a motor vehicle accident and admitted for diagnosis and surgical treatment. He sustained a crush injury to his right hand and presented with significant muscle damage, including multiple fractures and dislocations, an avulsion injury of the flexor tendons, and amputation of the distal phalanx of the little finger. He underwent reconstructive surgery and received HBOt over the following days. In the following 2 months, he lost the distal and middle phalanges of the little finger and recovered hand function. Posttraumatic compartment syndrome responds well to HBOt, which reduces edema and contributes to angiogenesis, as well as promoting the cascade of healing events. High-energy trauma causes massive cell destruction, and the blood supply is usually not sufficient to meet the oxygen demands of viable tissues. Hyperbaric oxygenation by diffusion through interstitial and cellular fluids increases tissue oxygenation to levels sufficient for the host’s responses to injury to work and helps control the delayed inflammatory reaction. HBOt used as an adjunct to surgical treatment resulted in early healing and rehabilitation, accelerating functional recovery. The results suggest that adjunctive HBOt can be beneficial for the treatment of crush injuries of the hand, resulting in better functional outcomes and helping to avoid unnecessary amputations.; Summary

Acute pyomyositis of the adductor magnus muscle involving the posterior and lateral thigh compartments: a case report of diagnosis and management: Rajesh Bawale, Jay Watson, Karshe Yusuf, Dilip Pillai, Bijayendra Singh; J Trauma Inj. 2022;35(2):139-143. Published online May 26, 2022; DOI: https://doi.org/10.20408/jti.2021.0022

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Abstract PDF

Bacterial infection of skeletal muscle can lead to the formation of abscesses. Primary pyomyositis is typically seen in tropical countries, and Staphylococcus aureus is the commonest causative organism. We present a case of acute adductor magnus muscle abscess (pyomyositis) with spread to adjacent thigh compartments via the perforators without iliopsoas muscle involvement. Due to the involvement of the entire thigh compartment, systemic antibiotic treatment alone was insufficient, whereas surgical drainage improved the clinical picture. The aetiological organism was S. aureus. Herein, we report the case of a patient who had primary pyomyositis, rather than a secondary type, that spread to the posterior and lateral aspect of the thigh through the second and third perforators, which pierce the adductor magnus muscle belly before entering the femur.

Summary

Citations

Citations to this article as recorded by

Wheel of misfortune: A unique case of MRSA pyomyositis of the adductor muscle group from blunt unicycle trauma
Jordan I. Gaelen, Toluwalase Awoyemi, Emmanuel Okematti, Meera Ramanathan
Clinical Case Reports.2023;[Epub] CrossRef

Original Article

Severity of grinder injuries and related factors compared with other high-rotation cutting tool injuries: a multicenter retrospective study from 2011 to 2018: Juni Song, Yang Bin Jeon, Jae Ho Jang, Jin Seong Cho, Jae Yeon Choi, Woo Sung Choi; J Trauma Inj. 2023;36(1):32-38. Published online May 25, 2022; DOI: https://doi.org/10.20408/jti.2021.0057

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Abstract PDF: Purpose
This study aimed to identify the characteristics of patients injured by high-rotation cutting tools and the factors related to the severity of their injuries.
Methods
Adult patients (≥18 years), who presented to the emergency department (ED) after a high-rotation cutting tool injury and who were registered in the Korean Emergency Department-based Injury In-Depth Surveillance (2011–2018) database, were included. Patients’ demographic characteristics, injury-related factors, and Injury Severity Scores were collected. All included cases were categorized into two groups according to the tool that caused the injury: grinder versus nongrinder. The characteristics of the two groups were compared, and the factors associated with the severity of injuries were investigated.
Results
Among 8,697 ED visits, 4,603 patients had been using a grinder and 4,094 had been using a nongrinder tool. The most frequently injured body part while using a grinder was the hand (46.4%), followed by the head (23.0%). While using a nongrinder tool, the most frequently injured body part was also the hand (64.0%), followed by the lower leg (11.4%). The odds of a severe injury were affected by patient age (odds ratio [OR], 1.024; 95% confidence interval [CI], 1.020–1.028) and using a grinder (OR, 2.073; 95% CI, 1.877–2.290). The odds of a severe injury using a grinder were higher in arm injuries (OR, 1.60; 95% CI, 1.40–1.83) and multiple-part injuries (OR, 1.998; 95% CI, 1.639–2.437). The odds of a severe injury using a grinder were lower for head injuries (OR, 0.481; 95% CI, 0.297–0.781).
Conclusions
Injuries from grinders were more likely to affect the head and neck than nongrinder injuries, despite the lower severity. The current lack of regulations on grinders in occupational safety and health standards warrants relevant legislation and the development of applicable safety equipment.; Summary

Case Reports

Successful management of a common carotid artery injury using a Pruitt-F3 Carotid Shunt: a case report: Kang Kook Choi, Jayun Cho, Min A Lee, Soo Min Eun, Yang Bin Jeon; J Trauma Inj. 2022;35(Suppl 1):S3-S7. Published online May 25, 2022; DOI: https://doi.org/10.20408/jti.2021.0032

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Abstract PDF: Penetrating neck injuries are a surgical challenge. In particular, penetrating neck injuries associated with carotid artery injuries have a high mortality rate. Overt external hemorrhage is unanimously considered as an indication for surgical exploration. The authors present a case of successful surgical management for a penetrating common carotid artery injury using a Pruitt-F3 Carotid Shunt (LeMaitre Vascular Inc., Burlington, MA, USA) in a 60-year-old male patient who was transferred to the level 1 trauma center due to a metal fragment piercing his neck while working. Active pulsatile bleeding was observed from the 3-cm-long external wound on the anterior neck in zone II. Emergent neck exploration showed near-total transection of the left common carotid artery just below the carotid bifurcation. After a Pruitt-F3 Carotid Shunt was applied to the injured carotid artery as a temporary vascular shunt, artificial graft interposition was performed for the injured common carotid artery. The patient experienced cerebral infarction as a complication caused by ischemia-reperfusion of the common carotid artery but was discharged in a suitable state for rehabilitation therapy.; Summary

Portal vein embolization in intrahepatic portal vein injury after blunt trauma: a case report: Sung Hoon Cho, Sang Yub Lee, Jung Geun Cha, Jihoon Hong, Sangcjeol Lee, Kyoung Hoon Lim; J Trauma Inj. 2022;35(Suppl 1):S31-S34. Published online May 19, 2022; DOI: https://doi.org/10.20408/jti.2022.0013

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Abstract PDF

Mortality from hepatic injury has declined over the last several decades for various reasons, including nonoperative management, such as angioembolization, in more than 80% of cases. Conversely, surgical treatment is preferred in intrahepatic portal vein injury due to several reasons. Here, we report a case that treatment of blunt traumatic liver injury accompanied by intrahepatic portal vein injury through portal vein embolization. A 29-year-old female patient was transferred to our trauma center for vehicular accident injuries. Contrast-enhanced abdominal computed tomography showed a massive hemoperitoneum and liver laceration (grade IV) with contrast extravasation suspected of the right portal vein branch but no other organ injury. Since vital signs were stable, we decided to perform nonsurgical radiologic intervention. Portography showed active bleeding of the posterior branch of the right portal vein. A pseudoaneurysm in the portal vein was embolized through percutaneous transhepatic portal vein puncture. On follow-up liver dynamic computed tomography performed 2 days after embolization, the posterior branch of the right portal vein was sufficiently embolized, and no liver parenchymal necrosis was observed. The patient was discharged without any complications 2 weeks later. This report suggests portal vein embolization as a good alternative treatment method for portal vein injury in patients with stable vital signs.

Summary

Citations

Citations to this article as recorded by

Portal vein embolization following arterial portography for the management of an active portal bleeding after blunt liver trauma in a cirrhotic patient
Romain L’Huillier, Bénédicte Cayot, Jean Turc, Laurent Milot
CVIR Endovascular.2024;[Epub] CrossRef

Management of a traumatic anorectal full-thickness laceration: a case report: Laura Fortuna, Andrea Bottari, Riccardo Somigli, Sandro Giannessi; J Trauma Inj. 2022;35(3):215-218. Published online May 19, 2022; DOI: https://doi.org/10.20408/jti.2021.0049

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Abstract PDF: The rectum is the least frequently injured organ in trauma, with an incidence of about 1% to 3% in trauma cases involving civilians. Most rectal injuries are caused by gunshot wounds, blunt force trauma, and stab wounds. A 46-year-old male patient was crushed between two vehicles while he was working. He was hemodynamically unstable, and the Focused Assessment with Sonography for Trauma showed hemoperitoneum and hemoretroperitoneum; therefore, damage control surgery with pelvic packing was performed. A subsequent whole-body computed tomography scan showed a displaced pelvic bone and sacrum fracture. There was evidence of an anorectal full-thickness laceration and urethral laceration. In second-look surgery performed 48 hours later, the pelvis was stabilized with external fixators, and it was decided to proceed with loop sigmoid colostomy. A tractioned rectal probe with an internal balloon was positioned in order to approach the flaps of the rectal wall laceration. On postoperative day 13, a radiological examination with endoluminal contrast injected from the stoma after removal of the balloon was performed and showed no evidence of extraluminal leak. Rectosigmoidoscopy, rectal manometry, anal sphincter electromyography, and trans-stomic transit examinations showed normal findings, indicating that it was appropriate to proceed with the closure of the colostomy. The postoperative course was uneventful. The optimal management for extraperitoneal penetrating rectal injuries continues to evolve. Primary repair with fecal diversion is the mainstay of treatment, and a conservative approach to rectal lacerations with an internal balloon in a rectal probe could provide a possibility for healing with a lower risk of complications.; Summary

A case report of “minor” trauma leading to a major disability: whiplash-associated dysphagia, dysphonia, and dysgeusia: Ami Schattner, Yair Glick; J Trauma Inj. 2022;35(2):115-117. Published online May 19, 2022; DOI: https://doi.org/10.20408/jti.2021.0043

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Abstract PDF: “Whiplash”-type injuries are commonly encountered and often cause neck pain, neck stiffness, and headaches. However, these injuries can have rare and poorly recognized complications, such as the development of a prevertebral hematoma leading to acute respiratory failure in the emergency department, followed by severe, life-threatening dysphagia and recurrent aspirations. In the patient described herein, a whiplash injury was accompanied by vocal cord paralysis and dysphonia (vagus nerve), dysgeusia (glossopharyngeal nerve, vagus nerve), and upper esophageal spasm (cricopharyngeal muscle, vagus nerve). It is unlikely that this was a complication of cervical fusion surgery. Instead, a combined stretch-induced lower cranial nerve injury, possibly on the exit of these nerves through the jugular foramen, seems to be a likely, but underappreciated mechanism occurring in rare instances of whiplash injuries.; Summary

Original Article

Age group analysis of patients with dog bite injuries who visited a single regional emergency medical center and factors affecting wound infections: Dong Ho Kang, Jea Yeon Choi, Woo Sung Choi, Jae Ho Jang, Jin-Seong Cho, Sung Youl Hyun; J Trauma Inj. 2022;35(2):84-91. Published online May 17, 2022; DOI: https://doi.org/10.20408/jti.2021.0046

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Abstract PDF: Purpose
The aim of this study was to analyze by age group the characteristics of patients with dog bite injuries, as well as determine which factors were associated with wound infections in those patients.
Methods
We reviewed patients with dog bite injuries who presented to Gachon University Gil Medical Center in Incheon, Korea from January 1, 2014 to December 31, 2018. They were classified by age group: children (0–18 years), adults (19–59 years), or elderly (≥60 years). Event profiles, wound characteristics, and infections were compared across these age groups. Multivariable logistic regression was used to identify factors associated with wound infections.
Results
Of the total 972 dog bite injuries, 272 (28.0%) were in children, 606 (62.3%) were in adults, and 94 (9.7%) were in the elderly. The median age was 30 years (interquartile range, 16–48 years) and the majority of patients (60.5%) were female. The most common place of injury was at home (73.8%) and indoors (77.0%). In children, the head and neck were the most frequent sites of injury (43%), while the most frequent site in adults and the elderly (50.8% and 59.6%, respectively) was the upper extremity. The odds ratio (OR) for wound infection was 3.997 (95% confidence interval [CI], 1.279–12.491; P=0.017) for head and neck injuries and 3.881 (95% CI, 1.488–10.122; P=0.006) for lower extremity injuries. The OR for wound infection was 4.769 (95% CI, 2.167–10.494; P<0.001) for significant injuries. Elderly patients had a higher risk for wound infection than other age groups (OR, 2.586; 95% CI, 1.221–5.475; P=0.013).
Conclusions
When analyzing patients with dog bite injuries, differences across age groups were found, with the elderly at the highest risk for significant injury and wound infection. It is recommended that age-specific approaches and strategies be used to prevent dog bite wound infections.; Summary

Case Report

Penetrating sacral injury with a metallic pipe: a case report and literature review: Mahnjeong Ha, Kyoung Hyup Nam, Jae Hun Kim, In Ho Han; J Trauma Inj. 2022;35(2):131-138. Published online May 11, 2022; DOI: https://doi.org/10.20408/jti.2021.0063

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Abstract PDF: Other than gunshot injuries, sacral penetrating injuries with a foreign body exiting to the other side are extremely rare. We encountered a case of sacral injury in which a long metallic pipe penetrated from the anus into the lower back of a patient. Since the pelvis contains various organs, management of a penetrating injury requires multidisciplinary treatment involving several medical specialties. Due to the infrequency of this type of injury, there are no definitive guidelines for effective management. We described our experience surgically treating a sacral penetrating injury and conducted a literature review. On this basis, we suggest a surgical strategy for treating this type of injury.; Summary

Original Articles

The incidence of unexpected delays in uploading outside radiologic images in the transfer of patients with major trauma: Si Jun Woo, Yong Oh Kim, Hyung Il Kim; J Trauma Inj. 2022;35(2):92-98. Published online May 11, 2022; DOI: https://doi.org/10.20408/jti.2021.0039

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Abstract PDF Supplementary Material: Purpose
Critically ill patients are frequently transferred from one point of care to a hospital that can provide a higher level of care. To achieve optimal treatment within the targeted window of time necessary for time-sensitive cases like major trauma, rapid transportation and decision making are essential. Transferred patients have often undergone radiologic imaging at the referring hospital. Examining these outside images is paramount. Therefore, this study was conducted to estimate the upload time of outside images.
Methods
This retrospective study was conducted from January to April 2020. Patients transferred from other hospitals with digitally recorded CDs or DVDs of radiologic or diagnostic images were included. When the patients were registered at the emergency department reception desk, the digital images were transmitted to our picture archiving and communication system using transmission software. The time of upload and the numbers of digital images were recorded. The time interval from patient registration to the time of upload was calculated.
Results
The median number of images was 688 in the trauma team activation (TTA) group (688 in the TTA group, 281 in the non-TTA trauma group, and 176 in the nontrauma group, respectively; P<0.001). The median upload time was 10 minutes. The longest upload time was 169 minutes. The upload time was more than 20 minutes in 12 cases (19.4%).
Conclusions
Patients with major trauma bring more images than patients with other diseases. Unexpected delays (>20 minutes) were noted in approximately 20% of cases. It is necessary to minimize this time.; Summary

The clinical pattern of intentional injuries at a primary Saudi Arabian trauma center: Bader Hamza Shirah, Hamza Asaad Shirah, Ibrahim Abdulaziz Zabeery, Osama Abdulqader Sogair, Ahmed Medawi Alahmari, Wael Awad Alhaidari, Maher Hamdan Alamri, Waal Nafa Aljabri; J Trauma Inj. 2022;35(2):99-107. Published online May 11, 2022; DOI: https://doi.org/10.20408/jti.2021.0026

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Abstract PDF: Purpose
The term “intentional injuries” refers to a spectrum of injuries resulting from self-inflicted injuries, interpersonal violence, and group acts of violence. Intentional injuries are underreported in Saudi Arabia. This study aimed to analyze and evaluate the characteristics of intentional injuries in patients who presented to the emergency department of a primary trauma center in Medina, Saudi Arabia in 2013.
Methods
A prospective cohort database analysis of the clinical patterns and treatment outcomes of 252 patients who had intentional injuries between January and December 2013 was done.
Results
The proportion of trauma patients with intentional injuries was 1.3%. The mean age was 34.2±9.4 years, 141 patients (56.0%) were males, and 111 (44.1%) were females (male to female ratio, 1.27:1). The majority (n=159, 63.1%) of injuries occurred at night. Most occurred outside the home (n=180, 71.0%). Financial problems (n=62, 24.6%) and social disputes (n=61, 24.2%) were the most common reasons. Sharp objects (n=93, 36.9%) were the most common weapons used. The head and neck were the most commonly injured areas (n=63, 54.4%). Superficial cuts (n=87, 34.5%), were the most common type of injury. Suturing of wounds (n=54, 21.4%) and surgical debridement (n=47, 18.7%) were the most commonly performed modalities of management.
Conclusions
We conclude that intentional injuries in Saudi Arabia are a health care hazard that is, unfortunately, underreported. The clinical pattern is similar in most aspects to international reports but differs in certain features due to the specific religious and conservative characteristics of the community. Nationwide clinical studies are strongly recommended.; Summary

Changes in patterns of plastic surgery emergencies at a level I trauma center in India during the COVID-19 pandemic: Veena Singh, Ansarul Haq, Sarsij Sharma, Sanjeev Kumar, Aditya Kumar, Amarjeet Kumar, Neeraj Kumar, Anil Kumar; J Trauma Inj. 2022;35(2):108-114. Published online May 11, 2022; DOI: https://doi.org/10.20408/jti.2021.0015

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Abstract PDF: Purpose
The coronavirus disease 2019 (COVID-19) pandemic has had major effects worldwide, including sudden and forceful setbacks to the healthcare system. The COVID-19 pandemic has also led to changes in the plastic and reconstructive management of emergency cases, including those due to road traffic accidents. This study analyzed changes in patterns of plastic surgery emergencies and modifications in consultation policies to minimize the exposure of healthcare workers.
Methods
Data on plastic surgery emergency calls received from the trauma and emergency department were collected for a period of 2 months before and during lockdown. The data were then analyzed with respect to the cause, mechanism, and site of the injury, as well as other variables.
Results
During lockdown, there was a 40.4% overall decrease in the plastic surgery emergency case volume (168 vs. 100). The average daily number of consultations before lockdown was 2.8 as compared to 1.6 during lockdown. Road traffic accidents remained the most common mechanism of injury in both groups (45.8% vs. 39.0%) but decreased in number during the lockdown (77 vs. 39). Household accidents, including burns, were the second most common cause of injury in both phases (7.7% vs. 20.0%), but their proportion increased significantly from 7.7.% to 20.0% in the lockdown phase (P=0.003). The percentage of minor procedures done in the emergency department increased from 53.5% to 72.0% during lockdown (P=0.002). Procedures in the operating room decreased by 73.1% during lockdown (67 vs. 18, P=0.001).
Conclusions
The COVID-19 pandemic and lockdown orders in India greatly influenced trends in traumatic emergencies as observed by the plastic surgery team at our tertiary care center. Amidst all the chaos and limitations of the pandemic period, providing safe and prompt care to the patients presenting to the emergency room was our foremost priority.; Summary

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