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Volume 16(2); December 2003
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Original Articles
Three-dimensional K-wire Support of a Nasal Bone Fracture Using a Fluoro scope
Eung Sam Kim, M.D., Beyoung Yun Park, M.D.*
J Korean Soc Traumatol. 2003;16(2):79-84.
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Background
Fracture of the nasal bone is the most common fracture of a facial bone because, among the other structures, A nose is prone to be traumatized. The nasal bone fracture is simply reduced by using the conventional closed reduction method. Though several temporary expedients have been introduced to stabilite the reduced bony segments, long-term follow-up study shows grave results. Materials and Methods: From May 1999 to Mar 2001, 34 patients with nasal bone fractures were treated. Before the reduction, the type of fracture was precisely evaluated and reduced using a fluoroscope. After the anatomical reduction of the nasal bone, including the nasal septum, had been made, two K-wires were introduced through the triangular space between the nasal bone and the bony nasal septum. The direction of the K-wire was decided based on the type of fractures. The inserted K-wires were removed 14 days after the operation. Results: In all 34 cases, good cosmetic and functional results were observed without complications, and during a short-term follow-up period, no recurrences were found. Conclusion: This method may be helpful for reductions and fixations of fractured segments, but above all, it is a much more comfortable method for the patients during their daily lives.
Summary
Abdominal Trauma by Cultiva tors in Rural Communities of Western Gyeongsang Southern Province
Young-Bae Na, M.D., Hyeong-Gon Moon, M.D., Soon-Tae Park, M.D., Woo-Song Ha, M.D., Sang-Kyung Choi, M.D., Soon-Chan Hong, M.D., Young-Joon Lee, M.D., and Eun-Jung Jung, M.D.
J Korean Soc Traumatol. 2003;16(2):85-89.
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Background
There are many accidents related to the use of farming devices or machinery in rural communities in Korea. Among them, accidents related to the use of farming tractors are relatively frequent and are accompanied by high mortality, especially in cases of abdominal injury. Materials and Methods: From among the 185 patients with cultivator-related injuries brought to the emergenay room of our hospital from January 1999 to September 2003, we reviewed 122 patients with appropriate medical records, and we made a retrograde analysis of their age, sex, mechanism of injury, hospital stay, and mortality. Results: In regard to the mechanism of injury, overturning was the most common (48 pati-ents, 39.3%), followed by handlebar injuries (30 patients, 24.6%). A comparison between the mechanisms of injury showed that head trauma were common in the overturning and fall-down, acctdents but chest and abdominal trauma were common in handlebar injuries. The incidence of receiving some kind of surgery and the mortality rate after cultivator-related accidents were higher in handlebar injuries (13/5 patients, 43.3%/16.7%) than in the overturning (13/2 patients, 27.1%/4.2%) or fall-down (4/2 patients, 17.4%/8.7%) injuries. Conclusion: Handlebar injuries are a significant cause of both blunt abdominal trauma and chest trauma. Safer handlebar designs may provide a health and economic benefit. Manufacturers of cultivators should be aware of these facts and should adjust the designs of the handlebars accordingly.
Summary
Review and Clinical Analysis of 112 Patient
Who Expired due to Burn Injury
Si-Uk Woo, M.D., Gyu Sung Choi, M.D., Do Hern Kim, M.D., Jun Hur, M.D., Wook Chun, M.D., and Jae-Jung Lee, M.D.
J Korean Soc Traumatol. 2003;16(2):91-98.
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Background
During the past several decades, advances in burn treatment, including the improvement in fluid ressusitation, the evolvement of antibiotics, and the early excision of the wound, have increased the survival rate of burn patients. How ever sepsis and organ dysfunction are major causes of death after burn trauma. This study focused on finding the demography of burn mortality and the cause of death and on characterizing the time course of severe burn injury. Method: From January 1, 2002, to December 31, 2002, 543 patients were treated at the Burn Unit of General Surgery, Han Gang Sacred Heart Hospital after burn trauma. Among them, 112 patients expired. We reviewed their medical records and analyzed their demography, the cause of death, and the survival period, retrospectively. Results: Among the 112 patient, the cases of death are most common in the male patients aged 40 to 49. The most common cause of burn was flame (94.6%). They expired from sepsis (63.39%), pulmonary complication (13.39%), burn shock (13.39%) and acute renal failure (6.25%). Unill 72 hours after the burn injury, burn shock was the most common cause of death, between the 3 rd day and the 7th day, pulmonary complications were the most common cause and after the 7th day, sepsis was. Conclusions: Even nowadays, many burn patients expire from burn shock and sepsis. Rapid transportation to a specialized burn center, judicious fluid ressusitation, wound care for wound healing, and prophylaxis of secondary infection can save more massive-burn victims.
Summary
Significance of the Motor Component of the Glasgow Coma Scale in Triage of Seve rely Injuried Patients
Jung Ho Shin, M.D.*, Sung Woo Lee, M.D., In Chul Jung, M.D., Su Jin Kim, M.D., Be An Lee, M.D., Sung Woo Moon, M.D., Sang Hun Jung, M.D., Nak Hoon Kim, M.D., Sung Hyuk Choi, M.D. Yun Sik Hong, M.D.
J Korean Soc Traumatol. 2003;16(2):100-105.
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AbstractAbstract PDF
Background
Severely injured patients need an optimal triage system that can differentiate those patients who require the resources of the trauma center from those who do not. American national guidelines recommend that patients with Glasgow Coma Scale (GCS) scores less than 14 or triaged-Revised Trauma Score (t-RTS) less than 11 should be triaged to trauma centers. Although, in many studies, the GCS score has been shown to be the strongest single prognostic predictor in trauma patients, the presence of unmeasurable components of the GCS limits its usefulness. Also, it is difficult for emergency medical technicians to estimate the GCS in a prehospital setting because of its complexity and the shortage of time. This study was designed to evaluate the efficacy of the motor component of the GCS in severely injured patients. We hypothesized that the motor component of the GCS (GCSM) would be equally sensitive as the total GCS in triage of severely injuried patients. Me thods: We reviewed a total of 114 patient who visited the Emergency Center of Korea University Ansan Hospital between December 2001 and September 2002. Of those 114 patients, 36 were excluded because of inadequate medical records or visiting after cardiac arrest. The parameters that we used as tools for analysi, were age, sex, GCS score, RTS, Injury Severity Score (ISS), actual survival rate (As), and probable survival rate (Ps). We defined severely injured patients (t-RTS ≤11) requiring care in a trauma center or intensive care unit. Based on American College of Surgeons Committee on Trauma (ACSCOT) guidelines, we defined GCS ≤13 as positive triage by GCS, ISS ≥16 as positive triage by ISS, and GCSM ≤5 as positive triage by the motor component of GCS. The sensitivity and the specificity were calculated, and a statistical analysis by t-test was conducted with two-tail αlevels of 0.05. Results: Of the 78 patients, the mean age was 44.7±2.2,and the mean ISS was 21.7±1.0. The GCSM was found to have a sensitivity of 85.7% and a specificity of 98.0% for t-RTS≤11. The GCS had a sensitivity of 89.3% and a specificity of 90.0% (p = not significant). Conclusion: Our results indicate that the motor component of GCS is a sensitive predictor of patients’poor prognosis and that the GCSM is equivalent to the GCS for prehospital triage. In view of the simplicity of the GCSM, its substitution for the GCS in triage systems might lead to a higher use rate among prehospital healthcare providers.
Summary
Prognostic Factors Related to Submerged Patients Treated at an Emergency Medical Center near a Beach
Yong Taeg Jeong, M.D., Se Hyun Oh, M.D., and Boo Soo Lee, M.D.
J Korean Soc Traumatol. 2003;16(2):107-114.
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Background
Drowning is the fourth most common cause of accidental deaths in Korea. The number of drownings in Korea has decreased, but the number of victims visiting our hospital has increased. If a prognosis is to be given and a poor outcome prevented, it is necessary to know the prognostic factors related to the submerged patients. Methods: The medical records of 126 submerged patients who visited our emergency department between January 1997 and December 2002 were reviewed retrospectively. These patients’ final outcomes were categorized into two groups: good (no neurological impairment) and poor (vegetative or dead). Demographic, clinical, laboratory, and treatment variables were compared between the two groups. The patients were classified in six subgroups using the following clinical parameters in the emergency department: presence of breathing, arterial pulse, pulmonary auscultation, and arterial blood pressure. Results: Among the 126 patients, 101 cases had a good outcome and 25 cases had poor outcome. There was a statistically significant difference between the two groups in respiratory rate, pH, PaCO2, bicarbonate, oxygenation index, serum glucose, and sodium (p<0.05). The six subgroups based on 4 clinical parameters showed significant differences in poor outcome rate. Among the 41 patients who were in cardiopulmonary arrest at scene, 30 patients were given prehospital CPR, and 16 given of them showed a good outcome. The remaining patients, 11 cases who were not given prehospital CPR had a poor outcome. Conclusion: Our results showed that immediate resuscitation prior to arrival at the emergency department was associated with a better clinical outcome in submerged patients. For the purpose of immediate and appropriate prehospital CPR, CPR education for paramedics, lifeguards, and the general populations is needed. To clarify the prehospital prognostic factors and to improve the prognosis for submersion victims, a systematized protocol should be developed which can assess and feed-back actions of prehospital persons.
Summary
Clinical Analysis of Patients with Thorax or Neck Trauma Treated with Emergent Operations
Sung Youl Hyun, M.D., Sang Woo Oh, M.D.*, Jae Kwang Kim, M.D.*, Yong Su Lim, M.D.*, Hyuk Jun Yang, M.D.*, Gun Lee, M.D.*, Wook Jin, M.D.**, and Eell Ryoo, M.D.***
J Korean Soc Traumatol. 2003;16(2):116-123.
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AbstractAbstract PDF
Background
Recently, the number of patients with the thorax or neck trauma has increased due to traffic accidents, industrial disasters, incidental accidents, and violence. Most of the thorax or neck injuries can be managed with conservative methods and simple surgical procedures, but an open thoracotomy or exploration will be necessary in emergent cases. Traumas to the thorax and the neck have an extremely poor prognosis when not diagnosed and treated early. Therefore, we analyzed the results of emergent operations in patients with thorax or neck trauma and their clinical courses. Methods: A clinical evaluation was performed on 56 patients treated with emergent operations for thorax or neck trauma from January 1997 to July 2003 according to their medical records. Results: There were 45 males and 11 females. The mean age was 36.1 years. The modes ofinjury were as follows: traffic accidents 14 cases, stab wounds 27 cases, industrial disasters 7 cases, and others 8 cases. The annual distribution of cases was as follows: 1997 year 9 cases, 1998 year 6 cases, 1999 year 7 cases, 2000 year 10 cases, 2001 10 cases, 2002 6 cases and 2003 8 cases. The injured organs were 13 cases of a ruptured diaphragm, 12 cases of a ruptured lung, 7 cases of a ruptured heart, 2 case of a ruptured aorta, 9 cases of a simple vessel ruptured and 4 cases of a ruptured esophagus and trachea. There were 9 (16%) overall deaths: 6 cases in deaths among the blunt-trauma cases and 3 deaths among the stab injury cases. Conclusion: Early diagnosis and surgical treatment is essential for thorax or neck trauma, to decrease the mortality and complications. Therefore, careful diagnostic procedure, appropriate preoperative management for hypovolemia, and early surgical treatment are essential. The setup an of emergency operation system should be considered as a reform measure.
Summary
Validation of the Ottawa Knee Rule in Acute Knee Injury
Sang Kuk Han, M.D., Hyoung Gon Song, M.D., Kuen Jeong Song, M.D., Yeon Kwon Jeong,M.D., Min Seob Sim, M.D., and Pil Cho Choi, M.D.
J Korean Soc Traumatol. 2003;16(2):124-127.
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Background
We performed this study to validate the Ottawa Knee Rule for determining the need for radiography in patients with acute knee injuries. Methods: A prospective study was performed from August 2001 to July 2002. The patient population was composed of a convenience sample of 242 eligible adults out of 453 adult patients with acute knee injuries. The attending emergency physician assessed each patient for standardized clinical variables and determined the need for radiography according to the decision rule. After the findings of clinical evaluation had been recorded, radiography was performed in each patient, irrespective of the determination of the rule. The rule was assessed for its ability to correctly identify fracture of the knee. Results: The decision rule had a sensitivity of 1.0 and a specificity of 0.46. The potential reduction in use of radiography was estimated to be 40%. The probability of a fracture, existing when the decision rule was negative, is estimated to be 0%. Conclusion: A prospective validation has shown the Ottawa Knee Rule to be 100% sensitive for identifying fractures of the knee and to have the potential to allow physicians to reduce the use of radiography in patients with acute knee injuries.
Summary
Clinical Evaluation of Pelvic Fractur in Geriatric Patients: A Retro's pective Clinical Review of 93 Cases
Hyun Chul Hwang, M.D., Hoon Pyo Hong, M.D., Dong Pil Kim, *M.D., Myung Chun Kim, M.D., Young Gwan Ko, M.D.
J Korean Soc Traumatol. 2003;16(2):129-135.
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AbstractAbstract PDF
Purpose
This study was performed to review our experience with geriatric pelvic fracture patients in our emergency center. Methods: Pelvic bone fracture patients who visited the emergency center of Kyung Hee University Hospital and Dongsuwon General Hospital from March 2001 to July 2003 were analyzed using a retrospective medical records review. Variables included in the data analysis were demographics, injury pattern, transfusion needs, and outcome of pelvic fractures in older versus younger patients. Results: We cared for 93 patients with pelvic fractures during the study period. The mean age was 38 years, 56% were men, and the mean Injury Severity Score (ISS) was 19. Overall mortality was 13%. Seventy-five percent were younger than 55 years, and 25% were older than 55 years. Severe pelvic fractures were more common in older patients. The initial systolic blood pressure was lower and the heart rate higher in older patients, although the ISS was not different between the two age groups. Older patients were 2.2 times as likely to undergo transfusion and those undergoing transfusion, required more blood. Lateral compression (LC) fractures occurred 2.7 times more frequently in older patients than anteroposterior (AP) compression fractures. Conclusion: In older patients, pelvic fractures are more likely to produce severe complications and sequelae. Fracture patterns differ in older patients, with LC fractures occurring more frequently and commonly causing significant blood loss. The outcome for older patients with pelvic fractures is significantly worse than it is for younger patients, particularly for higher injury severity. Recognition of these differences should help clinicians to identify patients at high risk for bleeding and death early and to refine diagnostic and resuscitation strategies.
Summary
Clinical Manifestation on Cases of Renal Injury with Nephrectomy
Kyung Seop Lee, M.D.
J Korean Soc Traumatol. 2003;16(2):137-141.
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AbstractAbstract PDF
Background
To evaluate retrospectively an clinical manifestation on cases of renal injury with nephrectomy, we reviewed our experiences with acutely renal-injured patient. Methods: The outcomes of treatments of 20 patients who had been managed by nephrectomy after renal injury were reviewed retrospectively with respect to age, sex, cause, clinical manifestations, physical examination, degree of renal injury (grade Ⅰ-Ⅴ), radiologic findings, injuries of other organ, complication and follow-up examinations. Results: Twenty patients with renal injuries who had undergone an explolaparotomy were identified. Seventeen (17) patients survived, but the and other three (3) patients died. The most common cause was motor-vehicle accidents (16 cases 80.0%). Clinical manifestations were flank pain in (14 cases 70.0%), drowsy mentality in (4 cases 20.0%), and gross hematuria in (1 case, 5.0%). Associated injuries were seen in 17 cases (85.0%). The most common associated injury was pneumothorax in 7 cases (18.9%). The causes of nephrectomy were a shattered kidney in 10 cases, hemodynamicinstability status in 6 cases, renal pedicle injury in 1 case, generalized peritonitis in 2 cases and urinoma formation in 1 case. Conclusion: Patients who undergo trauman ephrectomy tend to be severely injuried, and hemodynamicinstability was a major indication of nephrectomy.
Summary
Blunt Chest Trauma in Children
Tae Hee Won, M.D., Yeong Jin Jeon, M.D.*
J Korean Soc Traumatol. 2003;16(2):142-145.
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Background
Despite growing national attention, traumatic injury remains the most common cause of mortality in children, and the clinical manifestations of blunt chest trauma in children are different from those in adult. Methods: We reviewed retrospectively the cases of 45 children patients who were diagnosed with blunt chest trauma and managed in Mok-dong Hospital, Ewha Women’s University, from August 1995 to April 2003. Patients with a simple chest wall contusion were excluded. Results: The mean age was 6.5 ± 3.1 years, and 3-to 8-year-old children were most common. The main cause of blunt chest trauma was traffic accident (37 cases 82%, P<0.01). Pulmonary contusion was the most common injury (34 cases 76%), followed by rib fracture. Pulmonary contusion, tended to be prevalent at a younger age and rib fractures at a older age. However, this difference was not statistically significant (P>0.05). All patients were managed conservatively for chest injury, and two patients died of severe hypoxemia and hemorrhage. The mortality was 4%. Conclusions: The clinical manifestations of blunt chest trauma in children were different from those in adult, and most patients were managed conservatively with good results. More driver's attention is required to protect children from traffic accident, especially those involving larger car (vans, trucks, buses, and so on) and during backing a car.
Summary
Portal Venous Gas and Intestinal Pneumatosis Caused by Blunt Abdominal Trauma - A Case Report -
Yil Young Chen, M.D., Hoon Pyo Hong, M.D., Myung Chun Kim, M.D., Young Gwan Ko, M.D., and Dong Pil Kim, M.D.*
J Korean Soc Traumatol. 2003;16(2):147-150.
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AbstractAbstract PDF
Portal venous gas is a severe and life-threatening sign since it is associated with an overall mortality rate ranging from 75% to more than 90% in instances due to noniatrogenic causes, but its mechanism is still not fully understood. However, after blunt abdominal trauma, portal venous gas is found even if only rarely. Because of developments and improvements in diagnostic procedures, especially computed tomography and ultrasonography, portal venous gas and intestinal pnuematosis can detected, and treated early, and a recent study reported mortality rates as low as 29%. Therefore, in the emergency department, the emergency physician must pay attention to portal venous gas in patients with blunt abdominal trauma. Delay in diagnosis and treatment may lead to intra-abdominal catastrophe, sepsis, and increased mortality. We report a case of portal venous gas and intestinal pnematosis after blunt abdominal trauma.
Summary
Penet rating Esophageal Injury Diagnosed by using Methylene Blue - A case report -
Jung Min Ju, M.D., Sung Youl Hyun, M.D.*, Jae Kwang Kim, M.D.,
Yong Su Lim, M.D., and Gun Lee, M.D.
J Korean Soc Traumatol. 2003;16(2):152-155.
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AbstractAbstract PDF
Penetrating injury of the cervical esophagus cannot be easily identified by physical examination due to its deep anatomical location , so many patients with penetrating neck injuries should be undergone esophagography or esophagoscopy for the evaluation of potential esophageal injuries. However, these diagnostic procedures are invasive, time-consuming, expensive, and, most importantly limited by availability of resources (diagnostic equipment and manpower). We experienced a patient with a penetrating esophageal injury who was promptly diagnosed by using methylene blue. A 32-year-old male visited the emergency room complaining of dyspnea and bleeding after a penetrating neck injury.Thrty (30) minutes after the patient had swallowed the methylene blue solution, we found leakage of blue-colored fluid through the stab wound. He underwent emergent surgical repair without further investigations for esophageal injury.
Summary
Acute Myocardial Infarction Following Blunt Chest Trauma - A case report -
Jung Min Ju, M.D., Young In Kim, M.D., Jae Kwang Kim, M.D., Yong Su Lim, M.D., Hyuk Sun Yang,M.D., Gun Lee, M.D., Sung Youl Hyun, M.D.*, Seong Youn Hwang,M.D.**
J Korean Soc Traumatol. 2003;16(2):157-159.
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AbstractAbstract PDF
Blunt chest trauma can lead to cardiac complications ranging from simple arrythmias to myocardial rupture. Injury to coronary arteries with subsequent myocardial infarction after blunt chest trauma is rare, but carries a significant risk of morbidity and mortality. Therefore, rapid diagnosis and prompt treatment are reguired. Most coronary artery occlusions after trauma are caused by disruption of pre-existing atherosclerotic palque, so acoronary artery occlusion is unusual complication in a young man. We report the case of a previously healthy young man who developed acute myocardial infarction following blunt chest trauma.
Summary
Case Reports
Cardiac rupture due to Blunt Injury
Jin Hee Lee, M.D., Yoo Sang Youn, M.D., In Cheol Park, M.D., and Seung Ho Kim, M.D.
J Korean Soc Traumatol. 2003;16(2):161-162.
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AbstractAbstract PDF
Blunt injury to the heart ranges from a contusion to a cardiac rupture. Cardiac rupture, however, is uncommon and is associated with a very high mortality rate. We experienced a case of right atrial rupture caused by a compression to the chest wall. The patient was a 19-year-old male who suffered injury by being crushed under an elevator. We suspected cardiac tamponade caused by cardiac rupture with profound shock, elevated central venous pressure, and anterior chest wall bruise. Rapid diagnosis was done by using emergency sonography. Percutaneous pericardiocentesis was done. The patient was sent to O.R., and the right atrial rupture was repaired with a simple suture.
Summary
Carotid-C avernous Fistula With Internal Carotid Artery Dissection A ftera Craniofacial Trauma Injury - A case report -
Jin Seong Cho, M.D., Hyuk Jun Yang, M.D., Gun Lee, M.D., Chan Jong Yoo, M.D.*, Wook Jin, M.D.**, and Jae Gwan Lee, M.D.
J Korean Soc Traumatol. 2003;16(2):164-169.
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AbstractAbstract PDF
A carotid-cavernous fistula (CCF) is a pathologic arteriovenous communication between the carotid artery and the cavernous sinus, and the incidence of CCF as a result of craniofacial trauma is less than 0.2%. Traumatic internal carotid artery dissection (TICAD) is a rare phenomenon, occurring in 0.02 to 0.67% of cervical blunt trauma cases. We report a rare case of CCF associated with ICAD after craniofacial trauma injury,which is very rare. A 23-year-old woman presented with left ptosis on 21 days after a car crash accident. She had suffered from headaches, diplopia, tinnitus, and dizziness. Brain MRI revealed no mass or aneurysmal sac or intracranial hemorrhage, but cerebral angiography showed CCF with ICAD. She was treated with a ICAD percutaneous transarterial stent and endovascular embolization, 1 months after cerebral angiography. clinicians treating patients with craniofacial injuries should have a complete understanding of these patients’entity, because urgent intervention may improve outcome.
Summary
J Trauma Inj : Journal of Trauma and Injury
© The Korean Society of Traumatology.