Journal of Trauma and Injury

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Volume 18(2); December 2005

Review Article

Primary Survey of Cardiac Troponin I Elevated Groups in Trauma Patients: You Dong Sohn, M.D., Kyoung Soo Lim, M.D., Ji Yun Ahn, M.D., Jung Kuen Park, M.D., Gyu Chong Cho, M.D., Bum Jin Oh, M.D., Won Kim, M.D.; J Korean Soc Traumatol. 2005;18(2):81-86.

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Abstract PDF: Background
Cardiac troponin I (cTnI) is a sensitive cardiac marker of myocardial injury. In normal coronary angiogram, positive cTnI values may be detected in various events such as sepsis, stroke, trauma and so on. To investigate characteristics of cTnI positive group in trauma patients, we designed this study between cTnI positive group and cTnI negative group. Method: Trauma patients who visited emergency room within 24 hours after accidents were included. Patients who had renal failure, acute coronary syndrome, sepsis, spontaneous SAH were excluded. Retrospective study of 97 trauma patients was done. We investgated ISS (injury severity score), positive cTnI, EKG abnormality, shock class, ICU admission rate and mortality. R e s u l t: In comparing with non chest trauma group, chest trauma group, whose chest AIS (Abbreviated Injury Score) is more than 3 point, had significant values in ISS, positive cTnI, EKG abnormality, shock class and ICU admission rate. Also, in non chest trauma group, we found several patients whose cTnI level was positive. When non chest trauma group was divided into two subgroups, the mortality and shock class of positive cTnI group were higher than that of negative cTnI group. When all trauma patients were divided into two
groups, a positive cTnI group had higher values in ISS, shock class, ICU admission rate and mortality than that in a negative cTnI group. Conclusion: We found that cTnI were positive in patients of cardiac contusion but also in various trauma cases. In non chest trauma patients, we assumed that hypotension caused cTnI elevating. The cTnI could play a role in predicting prognosis in trauma patients.; Summary

Original articles

Bone Mineral Bensity and Bone Turnover Marke rs in Patients with Femur Fracture Who Visited the Emergency Department: Kyoung Mi Lee, M.D., Seung Baik Han, M.D., Jun Sig Kim, M.D., Kwang Je Baek, M.D., Seong Bin Hong, M.D.*, Kyoung Ho Moon, M.D.**, Joon Soon Kang, M.D.**, Seong-Hwan Yoon, M.D.***; J Korean Soc Traumatol. 2005;18(2):87-93.

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Abstract PDF: Backgound: The most frequent fracture seen at the emergency department (ED) in the elderly is a femur fracture whereas they do not know the degree of osteoporosis. We analyzed the degree of osteoporosis in patients with femur fractures and compared patients with only femur fractures (FX) to patients with femur and vertebral fractures (VX) by examining the clinical features, the bone mineral density (BMD), and biochemical markers. Methods: From January 2004 to December 2004, we enrolled prospectively 30 femur fracture patients who visited the ED. The bone mineral densities of the lumbar spine and the femur were examined. Total calcium, phosphate, alkaline phosphatase, osteocalcin, and serum C-terminal telopeptide (s-CTx) were measured. The patients with femur fractures were divided into two subgroups according to the presence of vertebral fracture. Results: All BMDs of the FX group showed osteoporosis. The s-CTx levels were higher than normal. The patients in the FX with VX were older than those in the FX only group, and had lower BMDs. There were no significant differences in markers between the subgroups, but the incidence of trochanteric fractures was higher in FX with VX group than in the FX only group. Conclusion: Femur fractures in the elderly were associated with osteoporosis. In our study, despite a considerable
difference in BMD between patients with femur fractures and those with femur fractures combined with vertebral fractures, there was no difference in biochemical markers on bone formation nor in the those of bone resorption. We will further investigate the biochemical markers and BMD in the population of osteoporotic fractures. So those indicators should be helpful for planning treatment and for prevention of FX in the elderly.; Summary

Epidemiologic Analysis of the Trauma Patients Visiting an Urban Specialized-emergency Medical Center: Gyu Chong Cho, M.D., Lee Sang Mun, M.D., Hui Dong Kang, M.D., You Dong Sohn, M.D., Bum Jin Oh, M.D., Won Kim, M.D., Kyoung Soo Lim, M.D.; J Korean Soc Traumatol. 2005;18(2):94-100.

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Abstract PDF: Background
Although trauma has been the major cause of death in korea, there are few reports describing the epidemiologic characteristics of trauma victims according to age-group. Thus, this study aimed to describe the epidemiologic characteristics of trauma victims visiting an urban emergency medical center in Korea. Method: This study was conducted with all trauma victims who visited the emergency departments of Asan Medical Center from April 11, 2005 to May 10, 2005. After the subjects were divided into three groups such as child (≤ 14 years old), adult(15-64 years old) and elderly(≥ 65 years old), the prehospital courses, injury mechanisms, injury severities and clinical results were compared. Result: Among total 5,927 patients who visited the emergency medical center, 896(15.1%) patients were trauma victims. Although child under the age of 15 comprised 28.7% of the total trauma victims, less severe injuries(injury severity score < 9) accounted for 97.7% of the cases. The hospitalization rate for injury among child was 21.5%. however, although elderly aged 65 comprised only 5.9% of the total trauma victims, more severe injuries(injury severity score ≥ 9) accounted for 30.2% of the cases. The hospitalization rate for injury among elderly was 56.4%. Conclusion: Patterns of injury and clinical results by age-group were considerably different. less evere and non-hospitalized injuries were more common in child than other age-groups. while severe and hospitalized injuries were common in elderly.; Summary

Original Articles

The Height of Fall as a Predictor of Fatality of Fall: Joo Hyun Suh, M.D., Eun Kyung Eo, M.D., Koo Young Jung, M.D.; J Korean Soc Traumatol. 2005;18(2):101-106.

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Abstract PDF: Purpose
The number of the deceased from free-fall is increasing nowadays. Free-fall comes to a great social problem in that even the survivor will be suffering for cord injury or brain injury, and so on. We analyzed the cases of free-fall patients to find out whether the injury severity is mainly correlated with the height of fall. Methods: We retrospectively investigated the characteristics of patients, who fall from the height above 2m from January 2000 to August 2004. We excluded the patients who transferred to other hospital, transferred from other hospital, and not known the height of fall. 145 patients were evaluated. Variables included in data analysis were age, height of fall, injury severity score (ISS), the being of barrier, and the survival or not. To find out the correlation between height of fall and death, we used receive operating characteristics (ROC) curve
analysis. Results: The mean age of patients was 36.5±19.4 years old. 110 were male and 35 were female. Mean height of fall was 11.1±8.5m. 51 patients (35.2%) were died and 30 patients of them (58.9%) got emergency room on dead body. The mean height of fall is 8.9±5.8m for 94 survivors and 15.2±11.0m for the 51 deceased (p<0.001). The area under the ROC curve was 0.646, which means the height of fall was not adequate factor for predicting for death. At 13.5m, as cut?off value, sensitivity is 52.9%, specificity is 86.2%, positive predictive value is 67.5% and negative predictive value is 77.1%. There were statistical differences in mortality rate and ISS between ‘below 13.5m group’and ‘above 13.5m group’, but there was not statistical difference in head and neck AIS. Conclusion: The height of fall is not adequate factor for prediction of death. So other factors like intoxication or not, the being of barrier or protection device need to be evaluated for predicting of free-fall patient’s death.; Summary

Conservative treatment of Osteoporotic Compression Fractures in Thoracolumbar spine: Kyu-Bok Kang, M.D., Young-Do Koh, M.D.; J Korean Soc Traumatol. 2005;18(2):107-111.

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Abstract PDF: Background
s: To evaluate the effectiveness of conservative treatment in osteoporotic thoraco-lumbar compression fractures and to identify the factors influencing the progression of compression. Materials and Methods: From January 2003 to October 2004, Patients who were admitted to our hospital for osteoporotic thoraco-lumbar compression fractures were reviewed retrospectively with follow-up more than 12 months (ave. 14.6 months). With simple x-ray lateral view, we evaluate wedge compression ratio (WCR) and kyphotic angle (KA) at initial and final follow-up. We separate the patients into two groups baesed on the amount of progression of vertebral compression and evaluate a relation with BMD, vertebral fracture level, initial WCR, initial KA. All datas were statistically analyzed. Results: An average of T-score was -3.5 and the changes of KA between initial and final follow-up were average 3.5°. Compression of anterior column were progressed to 8.5%. The changes between initial and final WCR in Group I (N=24) was 17.8%, and Group II (N=18) was 3.3%. T-score in group I was -3.4 and group II was -3.8 (p=0.228). vertebral fracture level were 10 T12, 12 L1, 2 L2 in group I; 6 T12, 6 L1, 6 L2 in group II (p=0.156). Initail WCR was 0.74 in group I, 0.63 in group II, and there was statistical difference between two groups(p=0002). Initial kyphotic angle was 13.9°in group I, 16.2°in group II repectively (p=0.392).
Conclusion: The conservative treatment with short-term bed rest and early embulation is effective and valuable method to patients who have osteoporotic thoraco-lumbar compression fractures. There was no statistical difference between two groups according to BMD, vertebral fracture level, KA. But in comparison with initail WCR between two groups, there was statistical difference. That means, in the case of small initial compression of anterior column, the progression of compression was bigger than else. In these patients, more strict use of appropriate brace and careful follow-up should be needed.; Summary

Efficacy of Transcatheter Arterial Embolization with N-Butyl Cya noacrylate in Acute Bleeding Patient: Hwan Jun Jae, M.D., Sang Youn Kim, M.D., Eui Jung Lee, M.D.*, Whal Lee, M.D., Gil Joon Suh, M.D.*; J Korean Soc Traumatol. 2005;18(2):112-118.

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Abstract PDF: Background
N-Butyl Cyanoacrylate (NBCA) is a liquid embolic material that can be useful for transcatheter arterial embolization (TAE) of acute bleeding especially in patients with coagulopathy, because it does not depend on coagulation for its therapeutic effect. The aims of this study were to evaluate the clinical efficacy and safety of TAE with NBCA in acute bleeding patients.
Methods: Between August 2003 and September 2004, TAE using NBCA for acute bleeding was performed in 23 patients (16 men, 7 women; mean age, 56.5years). The causes of bleeding were gastric ulcer (n=5), postoperative bleeding (n=4), post-biopsy bleeding (n=3), postpartum bleeding (n=3), duodenal ulcer (n=2), angiodysplasia (n=2), gastric lymphoma (n=1), iatrogenic injury (n=1), CMV gastritis (n=1), stab injury of the liver (n=1). TAE was performed using 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure-related complication and clinical outcomes were evaluated. Results: The angiographic and clinical success rate was 100% and 91.3% (21/23), respectively. There was no serious ischemic complication. Recurrent bleeding occurred in 2 patients (8.7%) and they were managed with successful second TAE (n=1) and endoscopic treatment (n=1). Nine patients (39.1%) had coagulopathy at the time of TAE and clinical success rate in this group of patients was 88.9% (8/9). Conclusions: TAE with NBCA is highly effective and safe treatment modality for acute bleeding patients, especially when the patient has a coagulopathy.; Summary

Clinical Investigation of Pediatric Blunt Thoracic Trauma: Tae Kyo Chung, M.D., Sung Youl Hyun, M.D.*, Jin Joo Kim, M.D., Eell Ryoo, M.D.**,
Kun Lee, M.D.,Jin Seung Cho, M.D.***, Sung Yun Hwang, M.D.†, Suk Ki Lee, M.D.††; J Korean Soc Traumatol. 2005;18(2):119-126.

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Abstract PDF: Background
Blunt thoracic trauma in children has a high morbidity and mortality. In this study, we assessed the significance of the injury pattern, mechanism and initial status in emergency department on severity and prognosis in pediatric blunt thoracic trauma patients. Method: We retrospectively reviewed medical records and chest X-ray and CT images of 111 pediatric blunt thoracic trauma patients from October 2000 to June 2005. Data recorded age, gender, season, injury mechanism, injury pattern, associated injury, length of hospital stay and cause of death. Result: Of all 111 patients, 68 patients were injured by motor vehicle accidents, 30 were falls, 5 were motorcycle accidents, 3 were sports accidents and 5 were miscellaneous. In thoracic trauma, single injury of lung contusion were 35 patients and 32 patients had multiple thoracic injuries. Hospital stay in school age group were longer than preschool age group. The causes of death were brain injury in 9, respiratory distress in 4, and hypovolemic shock in 2 patients. Emergently transfused and mechanically ventilated patients had higher mortality rates than other patients. Patients required emergency operation and patients with multiple thoracic injuries had higher mortality rates. Conclusion: In this study, patients with combined injury, emergency transfusion, mechanical ventilation, emergency operation, multiple injuries in chest X-ray had higher mortality rates. Therefore in these pediatric blunt thoracic trauma patients, accurate initial diagnosis and proper management is required.; Summary

The Comparison of Base Deficit, Lactate, and Strong Ion Gap as Early Predictor of Mortality in Trauma Patients: Kyung Hye Park, M.D., Kang Hyun Lee, M.D., Seon Hyu Kim, M.D., Sung Bum Oh, M.D., Joong Bum Moon, M.D., Hyun Kim, M.D., Sung Oh Hwang, M.D., Heon Ju Kim, M.D.*; J Korean Soc Traumatol. 2005;18(2):127-134.

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Abstract PDF: Purpose
Currently, there is a variety of systems available for predicting prognosis of trauma patients such as trauma score, Injury severity score (ISS) and acid-base variables. But it is not clear that the initial acid-base variables are predictors of prognosis in trauma patients at the emergency department. The objective of this study is to compare the base deficit, lactate and strong ion gap as an early predictor of mortality in trauma patients. Methods: Retrospective record review of 136 trauma patients needed to admit to intensive care unit via emergency department (June 2004 to February 2005). Data included age, injury mechanism, ISS, Revised trauma score (RTS), Multiple organ dysfunction score (MODS), Acute physiology and chronic health evaluation III (APACHE III), Glasgow coma scale (GCS), laboratory profiles, calculated anion gap and strong ion gap. Patients were divided into survivors and non-survivors, shock group and non-shock group with comparison by t-test;significance was assumed for p<0.05. Correlation between acid-base variables and mean arterial blood pressure (MABP) was evaluated. Results: There was a significant difference between the RTS (p=0.00), APACHE III (p=0.00), MODS (p=0.00), GCS (p=0.00) of survivors and non-survivors. There was no significant difference between the ISS (p=0.082), lactate (p=0.541), base excess (p=0.468) and SIG (p=0.894) of survivors and non-survivors. There was a significant difference between the RTS (p=0.023), APACHE III (p=0.002), lactate (p=0.000), base excess (p=0.000) and SIG (p=0.000) of shock and non-shock group. There was no significant difference between the ISS (p=0.270), MODS (p=0.442) and GCS (p=0.432) of shock and non-shock group. The base excess was most correlated to MABP (r2=0.150). Conclusion: Initial base deficit, serum lactate and SIG are not predictors of mortality in moderate to severe trauma patients. Initial base deficit, serum lactate and SIG are correlated with the mean arterial blood pressure in trauma patients in emergency department.; Summary

A Comparison of Characteristics in Dog Bite Patients: Sung Hwan Kim, M.D., Ji Young You, M.D., Ji Yeong Ryu, M.D.; J Korean Soc Traumatol. 2005;18(2):135-140.

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Abstract PDF: Background
s: Dog bite is the most common cause of animal bites. This study was conducted to analyze dog bite patients and to compare the differences of groups based on age.
Methods: We performed a retrospective analysis of patients admitted to our hospital after dog bite injuries from January 2003 through December 2004. The patients were divided into two groups based on age; group A (children, < 15 years) and group B (adult, ≥ 15 years). Results: A total of 103 patients were enrolled in the study. Dog bite injury frequently occurred to children under 10 years of age (21%). Home was the most common place of dog bite in group A, but public place was the most common in group B (p=0.000). Face was the most frequent body region of dog bite in group A, but hand was the most frequent in group B (p=0.039). Conclusions: From this study, we found statistically significant differences between the groups. Knowledge about age-related characteristics could result in improved prevention and treatment of these injuries.; Summary

Modified TRISS: A More Ac c u rate Predictor of In-hospital Mortality of Patients with Blunt Head and Neck Trauma: Dong Hoon Kim, M.D., In Sung Park, M.D.; J Korean Soc Traumatol. 2005;18(2):141-147.

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Abstract PDF: Purpose
Recently, The new Injury Severity Score (NISS) has become a more accurate predictor of mortality than the traditional Injury Severity Score (ISS) in the trauma population. Trauma Score Injury Severity Score (TRISS) method, regarded as the gold standard for mortality prediction in trauma patients, still contains the ISS as an essential factor within its formula. The purpose of this study was to determine whether a simple modification of the TRISS by replacing the ISS with the NISS would improve the prediction of in-hospital mortality in a trauma population with blunt head and neck trauma. Objects and Methods: The study population consisted of 641 patients from a regional emergency medical center in Kyoungsangnam-do. Demographic data, clinical information, the final diagnosis, and the outcome for each patient were collected in a retrospective manner. the ISS, NISS, TRISS, and modified TRISS were calculated for each patients. The discrimination and the calibration of the ISS, NISS, modified TRISS and conventional TRISS models were compared using receiver operator characteristic (ROC) curves, areas under the ROC curve (AUC) and Hosmer-Lemeshow statistics. Results: The AUC of the ISS, NISS, modified TRISS, and conventional TRISS were 0.885, 0.941, 0.971, and 0.918 respectively. Statistical differences were found between the ISS and the NISS (p=0.008) and between the modified TRISS and the conventional TRISS (p=0.009). Hosmer-Lemeshow chi square values were 13.2, 2.3, 50.1, and 13.8, respectively; only the conventional TRISS failed to achieve the level of and an excellent calibration model (p<0.001).
Conclusion: The modified TRISS is a more accurate predictor of in-hospital mortality than the conventional TRISS in a trauma population of blunt head and neck trauma.; Summary

Descriptive Study of the Clinical Characteristics of Trauma Patients in the West Southern Kyungsangnam-do Area: Chang Woo Kang, M.D., In Sung Park, M.D., Dong Hoon Kim, M.D.; J Korean Soc Traumatol. 2005;18(2):148-154.

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Abstract PDF: Purpose
This study was conducted to gather descriptive data on trauma victims and to observe the general demographic characteristics and clinical profile of trauma victims who were admitted to a regional emergency medical center in the west southern Kyungsangnam-do area.
Objects & Method: The study population consisted of 1,909 trauma patients who visited the emergency department of Gyeongsang National University Hospital between January 2003 and December 2004. The medical records were reviewed in a retrospective manner. Demographic data, the mechanism of injury, and clinical information were collected by three professional medical affairs recorders and an emergency physician and a Revised Trauma Score (RTS) and an Injury Severity Score (ISS) were calculated for each patient. Collected data were analyzed with SPSS software version 12.0. Results: Male patients outmembered female patients (M:F=2.54:1), and the mean age of the population was 4 0 . 5±21.4 years. The mean RTS and ISS were 7.45±1.11 and 8.40±7.44, respectively. The seventies showed the highest ISS(10.94±8.66). The most common mechanism of injury was motor-vehicle accidents (45.57%), followed by falls or slips(28.26%), and other blunt injuries(12.68%). The most frequent causes of death was cerebral herniation due to head injury(68.4%) and irreversible shock(26.3%). Conclusion: The present study clarified the demographic and clinical characteristics of trauma patients in the Kyungsangnam-do area. In the future, prospective clinical data collection is needed for a more sophisticated trauma study.; Summary

A Clinical Study of Free - Fall Patients in Emergency Department: Jae Kwang Lee, M.D., Jong Pil Choi, M.D., Seong Soo Park, M.D., Joon Seok Park, M.D.; J Korean Soc Traumatol. 2005;18(2):155-160.

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Abstract PDF: Background
Falls are a major cause of emergency room visits. Injury secondary to falls is a largely preventable public health problem. This study helps to better understand the epidemiology of falls from height, then develops prevention strategies. Methods: We reviewed the medical records of 192 patients admitted to the emergency department of Konyang university hospital with a history of falls from January 2004 to December 2004. Collected data included the patient’s age, gender, height of fall and method, outcome of management, Injury Severity Score(ISS). Results: According to the characteristics of height of fall, the ISS was higher when the patient fell from height of 2 meters or more(13.79±12.17) than not(8.13±9.25)(p<0.05). There were positive correlation between mean age and ISS(p<0.001, r=0.7). To gender, ISS was higher in the male group(12.73±11.78) than the female group(8.48±10.00)(p<0.05). Conclusion: Falls often results from multiple concurrent problems including environmental and behavioral factors. This study suggests that we need to improve the occupational environment, especially above 2meters, for decreasing injuries of fall from heights. Also we consider the prevention of children from injuries of fall from heights.; Summary

Nonoperative Management of Blunt Liver Trauma: Jung Ju Baik, M.D., Jung Il Kim, M.D., Seung Ho Choi, M.D., Young Cheol Choi, M.D., Si Youl Jun, M.D. Jun Ho Lee, M.D.*, Seong Youn Hwang, M.D.*; J Korean Soc Traumatol. 2005;18(2):161-171.

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Abstract PDF: Background
The management of hepatic injuries has changed dramatically during the past two decade after the technologic breakthroughs in radiologic imaging techniques. Recently, the non-operative management of blunt hepatic trauma has become the standard of care in hemodynamically stable patients. We reviewed our experience of the non-operative management of blunt hepatic trauma. And the purpose of this study was to examine the prognostic factors and indicators affecting the decision for treatment modality of emergent hepatic trauma. Methods: The medical records of 84 patients who were treated for blunt hepatic injury at Masan Samsung Hospital from January 2002 to December 2003. The patients were divided two groups, non-operative(Non-OP) and operative(OP), according to the treatment modality. The two groups were compares for age, sex, mechanism of injury, grade of liver injury scale, combined injury, systolic blood pressure, pulse rate, hemoglobin, hematocrit, WBC count, S-GOT, S-GPT, ALP, transfusion amount during initial 24 hours, amount of infused crystalloid fluid, length of ICU stay, length of ward care, morbidity and mortality. The grade of the liver injury were determined by using the organ injury scale(OSI). Results: Among the 84 patients, 46 cases(54.8%) were managed non-surgically, and 3 cases of Non-OP group were treated by transarterial embolization. Between the two groups, there were significant difference in age, injury grade, combined injury, hemoglobin, hematocrit, initial systolic blood pressure, amount of infused crystalloid fluid, amount of transfusion during the first 24 hours, and length of ICU care, morbidity and mortality. (p<0.05) The overall mortality rate was 8.3%, but 2.2% mortality in the non-operative group. Conclusion: Non-operative management may be considered as a first choice in hemodynamic stable patients with blunt liver trauma. The reliable indicators affecting the treatment modality of blunt hepatic trauma were systolic BP, Hb, Hct, amount of infused crystalloid fluid, amount of transfusion during the first 24 hours, liver injury grade and combined injury. Strict selection of treatment madality and aggresive monitoring with intensive care unit were more important.; Summary

Traumatic Ru p t u re of the Subcutaneous Bypass Vascular Gra ft - A case report -: Jung Eun Lee, M.D.*, In-Seok Jang, M.D., Jun Ho Yang, M.D., Sung-Hwan Kim, M.D., Jong Woo Kim, M.D., Jun Young Choi, M.D., Sang Ho Rhie, M.D., Ph.D.; J Korean Soc Traumatol. 2005;18(2):172-174.

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Abstract PDF: Trauma of the vascular structure is not poplular event. In obstructive atherosclerotic vascular disease, we sometimes have needed bypass surgery. The long length subcutaneous prosthetic vascular graft are vulnerable to injury. But prosthetic vessel rupture after trauma has been rare report. A 68-year-old man was referred to Department of Emergency of the Gyeongsang National University Hospital. After he had had a blunt trauma, he found a newly appearing pulsating mass of 10 cm diameter on his right chest wall. The lesion had a turbulent blood flow in the cavity of the mass by ultrasonographic finding. The lesion was a rupture of superficial prosthetic vascular graft under the skin.; Summary

Fat Embolism Syndrome Which Induced Significant Cerebral Manifestation Without Respiratory Distress: Hyung Geun Kim, M.D., Kyung Mi Lee, M.D., Ji Hye Kim, M.D.,
Jun Sig Kim, M.D., Seung Baik Han, M.D.; J Korean Soc Traumatol. 2005;18(2):175-178.

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Abstract PDF: Fat embolism syndrome is a collection of respiratory, neurological and cutaneous symptoms and signs associated with trauma and other disparate surgical and medical conditions. The incidence of clinical syndrome is low while the embolization of marrow fat appears to be an almost inevitable consequence of long bone fractures. The pathogenesis is a subject of conjecture and controversy. There are two theories which have gained acceptance(mechanical theory, biochemical theory). Onset of symptom is usually within 12 to 72 hours, but may manifest as early as 6 hours to as late as 10 days. The classic triad of fat embolism syndrome involves pulmonary changes, cerebral dysfunction and petechial rash. The cornerstone of treatment is preventing the stress response, hypovolemia and hypoxia and operative stabilization of fractures. Corticosteroid are the only drugs which have repeatedly shown a positive effect on the prevention and treatment of fat embolism syndrome. We report a case of post-traumatic fat embolism syndrome with severe cerebral involvement without respiratory distress. A 55 years old female had a traffic accident. She sustained pelvic bone fracture and both humerus fracture. Approximately 4 hours after the accident, mental status change developed without a focal neurologic deficits. She had no respiratory symptom and sign. Her brain MRI showed multiple cerebral fat embolism lesion. The patients received supportive treatment with corticosteroid, albumin. Her neurologic status stabilized over several days. After orthopedic surgery, she was discharged 62 days after admission.; Summary

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