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Volume 18(1); June 2005
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Review Article
General Scheme for the Level I Trauma Center in South Korea
Kug Jong Lee, M.D., Jae Yong Kim, M.D.*, Kang Hyun Lee, M.D.**, Gil Joon Suh, M.D.***, Yeo Kyu Youn, M.D.****
J Korean Soc Traumatol. 2005;18(1):1-16.
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AbstractAbstract PDF
An ideal trauma care system would include all the components identified with optimal trauma care, such as prevention, access, acute hospital care, rehabilitation, and research activities. Central to an ideal system is a large resource-rich trauma center. The need for resources is primarily based on the concept of being able to provide immediate medical care for unlimited numbers of injured patients at any time. Optimal resources at such a trauma center would include inhouse board-certified emergency medicine physicians, general surgeons, anesthesiologists, neurosurgeons, and orthopedic surgeons. Other board-certified specialists would be available, within a short time frame, to all patients who require their expertise. This center would require a certainvolume of injured patients to be admitted each year, and these patients would include the most severely injured patients within the system. Additionally, certain injuries that are infrequently seen would be concentrated in this special center to ensure that these patients could be properly treated and studied, providing the opportunity to improve the care of these patients. These research activities are necessary to enhance our knowledge of the care of the injured. Basic science research in areas such as shock, brain edema, organ failure, and rehabilitation would also be present in the ideal center. This trauma center would have an integrated concurrent performance improvement program to ensure optimal care and continuous improvement in care. This center would not only be responsible for assessing care delivered within its trauma program, but for helping to organize the assessment of care within the entire trauma system. This ideal trauma center would serve as a total resource for all organizations dealing with the injured patient in the regional area.
Summary
Original Articles
Chest Radiographic Parameters of Mediastinal Hemorrhage in Patients with Traumatic Aortic Injury Patients
Wook Jin Choi, M.D., Kyoung Soo Lim, M.D., Jae Ho Lee, M.D., Shin Ahn, M.D., and Won Kim, M.D.
J Korean Soc Traumatol. 2005;18(1):17-25.
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AbstractAbstract PDF
Background
Traumatic rupture of the aorta is a life-threatening injury that must be diagnosed as rapidly as possible and treated immediately. The chest X-ray is a valuable tool for screening traumatic rupture of the aorta in blunt chest trauma. And various chest radiologic parameters are being used as diagnostic tools for aortic injury. The purpose of this study is to identify chest radiographic parameters that may assist in the detection of traumatic rupture of the aorta and to compare these findings with those of other reports. Methods: This study involved 30 adult patients with traumatic rupture of the aorta seen at the emergency department of the Asan Medical Center from 1997 to 2004. The control subjects were 30 healthy patients with neither lung nor cardiovascular disease. We retrospectively assessed over 14 parameters on chest X-rays. Results: In 11 of the 14 parameters, there were significant differences between the study group and the control group. There was no significant difference in the M/C ratio (mediastinumto-chest width ratio) between the two groups, and neither the left nor the right paraspinal interface was statistically significant (p value>0.05). Our study indicates that new criteria for the MC ratio and for the paraspinal interfaces are needed for screening traumatic aorta injury. The other radiographic parameters for traumatic rupture of the aorta need to be further assessed through a prospective study.
Summary
Classification of Vertebral Body Fractures with Two-l evel Posterior Column Injuries of the Thoracolumbar Spine
Young-Do Koh, M.D., Hoon Jeong, M.D.*, and Sung-Gu Yeo, M.D.*
J Korean Soc Traumatol. 2005;18(1):26-32.
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AbstractAbstract PDF
Purpose
We evaluate the characteristics of vertebral body fractures in two level flexion-distraction injuries of the thoracolumbar spine Methods: The findings of radiographs, computed tomographs, and MRIs of 43 patients with flexion-distraction injuries combined with vertebral body fractures were retrospectively evaluated. We divided the patients with bursting fractures into two groups, the distractive group (posterior vertebral height ratio >1) and the compressive group (vertebral height ratio <1). Results: There were 23 compression fractures and 20 bursting fractures. In bursting fractures, the distractive group had 5 cases, and the compressive group 15 cases. In 24 cases (55.8%), the interspinous distances were widened. The average of the canal encroachment was 4% in the distractive group and 40% in the compressive group. At last follow-up, the average loss of correction was 2.0 degree in compression fractures and 2.7 degree in bursting fractures. Conclusion: The configurations of vertebral body fractures in flexion-distraction injuries of the thoracolumbar spine were varied as to the location of the axis of flexion. Because bursting fractures in flexion-distraction injuries had distractive or compressive features, one should consider that in establishing operative plan.
Summary
Comparison of the Trauma Outcome Between Secondary and Tertiary Hospitals
Suk Hyun Hong, M.D., Gap Su Han, M.D., Sang Hun Jung, M.D., Chung Min Chun, M.D., Sung Hyuk Choi, M.D., Sung Woo Lee, M.D., and Yun Sik Hong, M.D.
J Korean Soc Traumatol. 2005;18(1):33-40.
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AbstractAbstract PDF
Background
This study compared the performance of trauma care in an urban and a suburban hospital before and after the enhancement of emergency and intensive care. Method: The medical records of patients who were admitted to the intensive care unit following trauma from 1994 to 1995 and from 2002 to 2003 were examined. The standardized W (Ws), the 95% confidence interval (CI) of the Ws, and the predicted survival rate (Ps) were calculated. During each period, each hospital's actual survival rate was compared with the 95% CI of the Ps according to the revised trauma score (RTS) and injury severity score (ISS). Spell out RTS and ISS. Result: From 1994 to 1995, 225 and 121 records from the urban and the suburban hospitals were reviewed, respectively. The 95% CI's of the Ws were -2.30 to 2.73 and -11.40 to -5.90, respectively. The actual survival rate of the suburban hospital was significantly lower than the predicted survival rate at all RTS. From 2002 to 2003, 315 and 268 records from the urban and the suburban hospitals were reviewed, respectively. The 95% CI's of the Ws was -3.56 to 0.24 and -3.73 to 0.26, respectively. There was no difference between the actual survival rate and the predicted survival rate. Conclusion: An enlargement of the capacities of emergency and intensive care may improve the performance of trauma care at a small suburban hospital.
Summary
Antegrade Intra medullary Nailing in Traumatic Humeral Shaft Fractures
Eugene Kim, M.D.*, Hyung Sun Ahn, M.D., Young Joon Choi, M.D., Chung Hwan Kim, M.D., Jae Kwang Hwang, M.D., Jong Ha Lee, M.D.
J Korean Soc Traumatol. 2005;18(1):41-46.
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AbstractAbstract PDF
Background
We evaluated the clinical and the radiological results of treatment for humeral shaft fractures by using an antegrade intramedullary nail. Methods: Thirty-nine (39) cases of humeral shaft fractures treated with antegrade intramedullary nail were evaluated. Bone union was evaluated with simple radiographic findings, and a functional evaluation was done using the American Shoulder and Elbow Surgeons (ASES) score. Results: The average duration until union was 14.1 weeks. On the functional evaluation using the ASES score, 15 cases were excellent, 19 cases good, 3 cases fair, and 2 cases poor. Conclusion: We conclude that antegrade intramedullary nailing has a good clinical and radiological result for treatment of humeral shaft fractures.
Summary
Clinical Patterns of Penetrating To rso Injury at Emergency Department
Soon Young Yun, M.D., Young Jin Cheon, M.D., Tae Hee Won, M.D.*
J Korean Soc Traumatol. 2005;18(1):47-52.
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AbstractAbstract PDF
Background
This study was undertaken to evaluate the clinical pattern of the patients with penetrating torso injury. We retrospectively analyzed the clinical symptoms, mechanism of injury, injury type including injured organ, and ultimate outcome of treatment. Our purpose of the study was to establish guideline of management in penetrating torso injury. Methods: This study consists of an analysis of a consecutive series of 94 patients with penetrating injury of trunk treated at one general hospital during 7year period (from January 1995 to April 2003) who was admitted through in our emergency department. All data were collected from the medical records and entered in a database for analysis on the following: age, sex, mechanism of injury, vital sign at admission, clinical outcome including hospital mortality, length of hospital stay, length of intensive care unit stay, requirement of crystalloid fluid and blood product. Results: Among 94 patients, there were 68 men and 26 women, with ages ranging from 19 to 82 years (average 38.2 years). The most frequent mechanism of injury was violence by others including rob (n=54, 57.4%) followed by suicidal attempt (n=24, 25.5%) and accidental injury (n=16, 17.0%). No injury was inflicted from gun. In 37 patients, systolic blood pressure at admission was under 90mmHg. The time interval from injury to admission, and from admission to operation was 57.8minutes and 4hour 12minutes each. Laparotomy was required in 70 patients, thoracotomy in 5 patients, and 3 patients required thoracotomy and laparotomy. Among 94 patients, an average of 1.7 organs were injured. The small bowel and colon were the organs most commonly wounded followed by liver, mesentery, pleura. Of the 94 patients, 6 died for an overall mortality rate of 6.4%, and two of them were not related with hemorrhage. The average length of hospital stay was 18.1 days, and 40 patients required ICU care. Conclusion: Of the 94 patients who were admitted from penetrating torso injury, no patient was injured from firearm. Overall mortality rate was 6.4%. In our hospital, firearm injury was relative rare
Summary
The Effect of Methylene Blue on Inducible Nitric-oxide Synthase in
a Rat Model of Acute Lung Injury Induced by Paraquat
Hyun Soo Park, M.D., Chang Hyun Lee, M.D.*, Sung Goo Jung, M.D., Gil Joon Suh, M.D., Sung Eun Jung, M.D.**, and Yeo Kyu Youn, M.D.*
J Korean Soc Traumatol. 2005;18(1):53-63.
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AbstractAbstract PDF
Purpose
This study was designed to determine if methylene blue inhibited the lipid peroxida-tion, the production of NO, and the gene expression of iNOS in acute lung injury induced by paraquat and if the inhibitory effect was dose dependent. Methods: Female Sprague-Dawley rats were divided into four groups: the control group, the group treated with paraquat only, the group treated with paraquat and a low dose of methylene blue (2 mg/kg), and the group treated with paraquat and a high dose of methylene blue (20 mg/kg). Methylene blue was administered via the jugular vein 1 h after paraquat administration, and animals were sacrificed 6 and 24 h after paraquat administration. Malondialdehyde (MDA) as lipid peroxidation, reduced glutathione (GSH) as an antioxidant defense, the plasma NO concentration, and the expression of iNOS mRNA in the lung tissue were measured Results: Lung MDA contents decreased, with no significant difference between the methylene-blue groups and the paraquat-only group. Lung GSH contents were significantly elevated at 24h in the methylene-blue groups compared with the paraquat-only group. Plasma NO concen-trations were significantly reduced at 6 and 24 h in the methylene-blue groups compared with the paraquat-only group. There was also a significant decrease in the plasma NO concentration at 6 h in the high-dose methylene-blue group compared with the low-dose methylene-blue group. The expression of iNOS mRNA in the lung tissue was slightly decreased in the methylene-blue groups. It was also markedly increased at 24 h in the paraquat-only group compared with the methylene-blue groups. The gene expression was relatively decreased in the high-dose methylene-blue group compared with the low-dose methylene-blue group. Conclusion: This study suggests that methylene blue has an inhibitory effect on the plasma NO concentration and the expression of iNOS mRNA in lung injury induced by paraquat. No inhibitory effect of methylene blue on lipid peroxidation or dose-dependent inhibitory effects were clearly shown.
Summary
Surgical Treatment Using a Lateral Approach in Intra-articular Fractures of the Calcaneus
Young-Do Koh, M.D., Hoon Jeong, M.D.*, and Young-Sam Kwon, M.D.*
J Korean Soc Traumatol. 2005;18(1):64-69.
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AbstractAbstract PDF
Purpose
We report the radiologic and the clinical results for surgical treatment of calcaneal fractures involving the subtalar joint. Methods: We evaluated the findings of radiographs and computed tomographs of 39 patients (40 cases) with intra-articular calcaneal fractures. The fractures were treated with open reduction via an extended lateral approach and internal fixation using a plate. We assessed the radiologic results, such as the Böhler angle, the Gissane angle, and the height/width ratio. We assessed the clinical results based on the critieria of Salama et al. Results: According to the Essex-Lopresti classification, 9 cases were classified as tongue type and 31 cases as joint depression type. According to the Sanders classification, 10 cases were classified as type IIA, 4 cases as IIB, 16 cases as IIIAB, 4 cases as IIIAC, and 6 cases as type IV. The mean preoperative Böhler angle was 7.7, the mean postoperative Böhler angle was 21.1, and the mean last follow-up Böhler angle was 16.8. Clinical results classified as 10 excellent, 13 good, 11 fair, and 6 poor. Conclusion: In the treatment of intra-articular fractures of the calcaneus, open reduction via an extended lateral approach seems to be a useful method in that it can provide direct exposure of the subtalar joint with little morbidity.
Summary
Temporary Abdominal Cove rage with Malex Mesh Prosthesis in Cases of Seve rely Injured Abdominal Trauma Patients
Yeon Woo Kim, M.D., Yong Sik Jung, M.D.*, Wook Hwan Kim, M.D.*, Young Gi Min, M.D., Ki Woon Kim, M.D., Kug Jong Lee, M.D.
J Korean Soc Traumatol. 2005;18(1):70-78.
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AbstractAbstract PDF
Background
Abdominal compartment syndrome has multiple etiologies that are not only related to trauma but also any problem condition in the absence of abdominal injury. To determine whether prevention of the abdominal compartment syndrome after celiotomy for trauma victims justifies the use of temporary abdominal coverage with monofilament knitted polypropylene mesh (Malex mesh) in severely injured patients. Method: Medical records at the Ajou University Medical Center were reviewed for a 32-month period from May 1st, 2002 to December 31st, 2004. Twenty-nine consecutive patients requiring celiotomy who were survived until at the end of celiotomy received temporary abdominal coverage and staged abdominal repairs with Malex mesh. One of them was dissecting aortic aneurysm patient and the others were all trauma victims. Malex mesh prosthesis coverage was used in cases of abdominal compartment syndrome due to excessive fascial tension, severe bowel edema and retroperitoneal hemorrhage or edema followed by staged abdominal repairs. Result: Eighteen of twenty-nine patients were survived. Demographic characteristics, injury severity number of abdominal-pelvic bone injuries, mortality rate, complications, number of operations for permanent closure, required time for permanent closure showed no difference between man and women or child and adult. Except one dissecting aortic aneurysm patient, trauma cases showed 3.24±0.98 injury sites. All cases that received temporary abdominal coverage and staged abdominal repairs did not show abdominal compartment syndrome. 10.08±5.85 days and 2.27±0.82 times of operation required making permanent abdominal closure after temporary abdominal coverage followed by staged abdominal repairs. Most of surviving patients have shown antibiotic-resistant organism and fungus infection. Patients who received permanent closure recovered from infectious problem completely. Conclusion: The use of Malex mesh for temporary abdominal coverage in severely injured patients undergoing celiotomy was effective treatment method.
Summary

J Trauma Inj : Journal of Trauma and Injury