Journal of Trauma and Injury

Volume 19(2); December 2006

Original Articles

The Influence of the Regional Weather in Geriatric Trauma: Jung Ho Kim, Byung Soo Do, Sam Beom Lee, Sung Hoon Lee, Jong Won Si, Jae Young Lee, Oh Lyong Kim; J Korean Soc Traumatol. 2006;19(2):97-104.

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Abstract PDF: PURPOSE
Many factors influence the occurrence and severity of geriatric trauma, and regional weather is regarded as one factor that influences geriatric trauma. In this study, to predict the type, severity, and incidence of geriatric trauma patient, we analyzed the influence of regional weather on geriatric trauma.
METHODS
The subjects of our investigation were trauma patients over sixty-five years of age who visited the Emergency Department (ED) of Yeungnam University Hospital during a one-year period. We retrospectively reviewed the medical charts of 436 geriatric trauma patients, and the data were analyzed by using SPSS 12.0 for Window. The weather was based on data from the Korea Meteorological Administration.
RESULTS
The average age was 72.8 years old, and the ratio of males to females was 1:1.1. The mean spell out ISS was 10.8, and no difference was found between males and females. Slips were the most common cause of trauma. The largest numbers of aged trauma patients, 46, visited the ED in May, and the smallest number of such patients, 24, visited the ED in December. In addition to, summer saw the largest number of aged trauma patients. The type of trauma, the Injury Severity Score, and the number of patients had no relationship with season. On sunny days, the ISS was larger in patients who had hypotension and who had tachycardia. On rainy day, the ISS was larger in male patients and cultivator accident patients. The number of patients was larger on partly cloudy days.
CONCLUSION
In spring and summer and on partly cloudy days, we must be prepared to treat aged traumatized patients in the E.D. On rainy days, visual sensation, tactual sense, and acoustic sense must be closely examined. In addition,on rainy day, aged male traumatized patients or cultivator accident patients must to be closely observation.; Summary

Characterization of Peroxiredoxins in the Gray matter in the spinal cord after Acute Immobilization Stress: Nam Hyun Paek, Seung Soo Kwak, Dong Seok Lee, Young Ho Lee; J Korean Soc Traumatol. 2006;19(2):105-112.

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Abstract PDF: PURPOSE
Many stresses produce reactive oxygen species and bring about mechanism of antioxidant reaction. Cytokine and a neurotransmitter through the cell membrane, as well as signal transduction through the cell membrane, are used for various pathological condition of the brain, such as neurodegenerative disease. There are several antioxidant enzymes in cells (superoxcide dismutase, glutathion peroxidasae, peroxiredoxin catalase, etc.) METHODS: This study used single- or double-label immunohistochemical techniques to analyze mouse spinal neuron cells expressing Prx I and Prx III after acute mobilization stress.
RESULTS
Prx I was observed in dendritic cell of the gray matter of the spinal cord, and Prx III was observed in the cytoplasm of the GM of the spinal cord.
CONCLUSION
The results of this study will help to explain differences of expression in the distributions of the peroxiredoxin enzymes of the spinal cord.; Summary

Clinical Characteristics and Prognosis of Heat Stroke: Noh Han Park, Hyun Wook Ryoo, Kang Suk Seo, Jung Bae Park, Jae Mung Chung; J Korean Soc Traumatol. 2006;19(2):113-120.

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Abstract PDF: PURPOSE
The aim of this study was to evaluate the clinical characteristics of classic heat stroke in Korea and to identify factors of prognosis for heat stroke by comparing a survival group with a non-survival group.
METHODS
We retrospectively analyzed 27 patients with heat stroke who visited the Emergency Department of Kyungpook National University Hospital from March 2001 to February 2005. First, we divided the patients into two groups, the classic heat stroke group and the exertional heat stroke group, and compared them. Second, we compared the survival group with the non-survival group. Age, sex, cause, place where patients were found, underlying diseases, cooling time, performance of endotracheal intubation, initial Glasgow Coma Scale, initial vital sign, and laboratory findings were reviewed.
RESULTS
Five of 27 patients in heat stroke died. The classic heat stroke group had 20 patients. They were old and had more patients in the bathroom than the exertional heat stroke group had. The non-survival group showed lower blood pressure, lower initial GCS score, and higher respiratory rate than the survival group. In laboratory findings, the non-survival group also showed lower HCO3-level, lower albumin level, lower glucose level, more prolonged PT, and higher CK-MB level than the survival group. Delay in recognition of heat stroke and cooling were poor prognostic factors in heat stroke.
CONCLUSION
The classic heat stroke group had patients who were old and found in the bathroom. Early recognition and treatment of heat stroke is important to reduce mortality. Cooling time, initial GCS score, mean arterial pressure, resipratory rate, HCO3-, PT, CK-MB, and albumin seem to be meaningful when forming a prognosis for heat stroke patients.; Summary

Evaluation of the Educational Efficacy of a Cadaver-based Model for Teaching a Simple Suture Technique to Medical Students: Hyun Soo Do, Jin Hong Min, Seung Woo Hong, Sang Kyoon Han, In Soo Kim, Seung Ryu, Jin Woong Lee, Seung Whan Kim, In Sool Yoo; J Korean Soc Traumatol. 2006;19(2):121-125.

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Abstract PDF: PURPOSE
There is ongoing demand to deliver better procedural training to medical students in the emergency department. Thus, we studied the efficacy of a cadaver-based training model for teaching simple suture techniques to medical students.
METHODS
We investigated ten fourth-year medical students, who were rounding and being trained in the Emergency Department of Chungnam National University Hospital. They were educated with slides about a simple suture technique for 30 minutes to evaluate the efficacy of the cadaver-based training model. We prospectively measured their skill by administering a test on the cadaver-based simple suture technique in 3cm sized linar wound separately to each of them.
RESULTS
A total of ten fourth-year medical students completed the investigation. The tension, the direction of suture, the degree of cleanness, the number of sutures, the adequacy of the cutting thread length, and the suturing time in the first attempt were compared with those in the second one. The second results were compared with those in the third one, and the third results were compared with those in the fourth one. All the results had statistical significance.
CONCLUSION
These findings support the value of the cadaver-based simple suture technique training model as a medical student teaching model. The cadaver-based simple suture technique teaching model is a good way of teaching several medical skills to medical students.; Summary

Kinematical Characteristics of the Translational and Pendular Movements of each Cervical Vertebra at the Flexion and Extension Motion: Sung Hyuk Park, Han Sung Choi, Hoon Pyo Hong, Young Gwan Ko; J Korean Soc Traumatol. 2006;19(2):126-134.

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Abstract PDF: PURPOSE
The aim of this study was to determine the kinematical characteristics of the pendular and the translational movements of each cervical vertebra at flexion and extension for understanding the mechanism of injury to the cervical spine.
METHODS
Twenty volunteers, young men (24~37 years), with clinically and radiographically normal cervical spines were studied. We induced two directional passive movements and then took X-ray pictures. The range of pendular movement could be measured by measuring the variation of the distance between the center point of two contiguous cervical vertebrae, and the range of translational movement could be measured by measuring the variation of the shortest distance between the center point of a vertebra and an imaginary line connecting the center points of two lower contiguous cervical vertebrae. The measurements were done by using a picture archiving and communicating system (PACS).
RESULTS
The total length of all cervical vertebrae in the neutral position was, on average, 133.66 mm, but in both flexion and extension, the lengths were widened to 134.83 mm and 134.79 mm, respectively. The directions of both the pendular and the translational movements changed at the 2nd cervical vertebra, and the ranges of both movements were significantly larger from the 5th cervical vertebra to the 7th cervical vertebra for flexion and combined flexion and extension motion (p<0.05).
CONCLUSION
The kinematical characteristics for flexion and extension motions were variable at each level of cervical vertebrae. The 1st and the 2nd cervical vertebrae and from the 5th to the 7th cervical vertebrae were the main areas of cervical spinal injury. This shows, according to "Hook's law," that the tissues supporting this area could be weak, and that this area is sensitive to injury.; Summary

Usefulness of FAST for Evaluation of Blunt Abdominal Trauma Patients: Yong Sik Chu, Ok Jun Kim, Sung Uk Choi, Jung Han Lee; J Korean Soc Traumatol. 2006;19(2):135-142.

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Abstract PDF: PURPOSE
We planned to determine the diagnostic capability of focused assessment with sonography for trauma (FAST) in cases of blunt abdominal injury (BAI).
METHODS
A retrospective analysis of FAST sheets was performed from April 2002 to December 2004. During the study period, 135 BAI patients were evaluated with FAST at the Emergency Department of Bundang CHA Hospital. Of this group, twenty-eight patients were excluded, leaving 107 patients for analysis. Abdomen CT (computerized tomography) or exploratory laparotomy confirmed the presence of hemoperitoneum. At the secondary survey, patients underwent a three-view FAST examination (LogicQ; General Electric, Waukesha, USA) by an emergency physician, followed within 2 hours by an abdomen CT or exploratory laparotomy. The FAST examination was considered positive if it demonstrated evidence of free intra-abdominal fluid.
RESULTS
There were 45 true-positive FAST examination, 57 true-negatives, 1 false-positive, and 4 false negatives (sensitivity 91.8%, specificity 98.3%, positive predictive value 97.8%, negative predictive value 93.4%). The area under the ROC curve was 0.951 for the FAST examination.
CONCLUSION
FAST is a highly reliable method for screening patients suspected of having BAI for the presence or absence of hemoperitoneum.; Summary

A Clinical Analysis of Abdominal Stab Injuries: Jae Woong Han, Byung Chun Kim, Jae Pil Jung, Ji Woong Cho, Bong Hwa Chung, Kyung Suk Chung, Koo Hyun Kang; J Korean Soc Traumatol. 2006;19(2):143-149.

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Abstract PDF: PURPOSE
This study was done to evaluate the incidence, type of injury, medical consequences, mortality, and prognostic factors associated with stab wounds in patients who visited Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea.
METHODS
A retrospective analysis of the clinical data of 40 patients with abdominal stab wounds who visited Kangnam Sacred Heart Hospital, Hallym University, Seoul, Korea from January 1, 2000 to December 31, 2004.
RESULTS
1) The most prevalent age group was patients in their the twenties to fourties (77.5% of all patients), and average age of the patients was 39.3 years. The male-to-female ratio was 2.07:1. 2) The external site of stab wounds was most commonly the periumbilcal area of the abdomen (14 cases, 33.3%). 3) The most commonly injured organs were the liver and the stomach (10 cases each, 16.9%). 4) Operations were performed on all 40 patients, with 9 (22.5%) negative operation findings. 5) Death occurred in 5 cases (12.5%). 6) The trauma indices of the death group were TRISS 51.9%, RTS 3.6 points, and APACHE II 23.0 points. 7) The average transfusion amount of the death group was 13.8 pints CONCLUSION: These data suggest that the transfusion amount and the trauma index of abdominal stab injuries may be statistically significant factors for predicting mortality.; Summary

Correlation Between Facial Fracture and Cranial Injury: Seung Won Lee, Suk Jin Cho, Seok Yong Ryu, Sang Lae Lee, Sung Eun Kim, Sung Jun Kim, Ji Young Ahn; J Korean Soc Traumatol. 2006;19(2):150-158.

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Abstract PDF: PURPOSE
There are two theories about the relationships between facial fractures and cranial injuries. One is that facial bones act as a protective cushion for the brain, and the other is that facial fractures are the marker for increased risk of cranial injury. They have been debated on for many years. The purpose of this study is to identify the relationship between facial fractures and cranial injuries.
METHODS
A retrospective study was performed on 242 patients with facial fractures. The data were analyzed based on the medical records of the patients: age, gender, cause of injury, Injury Severity Score (ISS), alcohol intake, type of facial fractures, and type of cranial injury. The patients were divided into two groups: facial fractures with cranial injury and facial fractures without cranial injury. We compared the general characteristics between the two groups and evaluated the relationship between each type of facial fracture and each type of cranial injury.
RESULTS
Among the 242 patients with facial bone fractures, 96 (39.7%) patients had a combination of facial fractures and cranial injuries. Gender predilection was demonstrated to favor males: the ratio was 3:1. The mean age was 36.51+/-19.63. As to the injury mechanism, traffic accidents (in car, out of car, motorcycle) were statistically significant in the group of facial fractures with cranial injury (p=0.038, p=0.000, p=0.003). The ISS was significant, but alcohol intake was not significant. No significant relationship between facial fractures and skull fractures was found. Only maxilla fractures, zygoma fractures, and cerebral concussion had a significant difference in cranial injury (p=0.039, p=0.025).
CONCLUSION
There is a no correlation between facial fractures and skull fractures, which suggests that the cushion effect is the predominent relationship between facial fractures and cranial injuries.; Summary

Triage Score as a Predictor of need for Tertiary care Center Transport from Scene by Helicopter: Song Won Song, Jae Chol Yoon, Boo Soo Lee, Woo Joo Kim, Ji Yoon Ahn, Bum Jin Oh, Kyung Su Lim; J Korean Soc Traumatol. 2006;19(2):159-163.

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Abstract PDF: PURPOSE
The number of patients transported by the Helicopter Emergency Medical Service (HEMS) has increased recently. In our review of the Korean HEMS, there was no established helicopter utilization criteria or triage tool on the scene, so many patients with minor injuries were transported to tertiary care centers. The aim of this study is to evaluate the percentage of patients with minor injuries and to propose a more appropriate triage tool for predicting the need for transport to a tertiary care center.
METHODS
The subjects of this study were 59 trauma patients transported to Asan Medical Center (AMC) from the scene by Seoul HEMS from January 2004 to December 2005. The Triage score (TS), Injury Severity Score (ISS), and modified Canadian Triage and Acuity Scale (mCTAS) were calculated as severity scales. Patients with minor injuries were defined as those with TS=9, ISS< or =15, and mCTAS> or =3. We evaluated the association of TS, ISS, and mCTAS with the appropriateness of transport.
RESULTS
Many of the patients transported to tertiary medical centers were classified as having a minor injury: TS=9 group 35 cases (72.9%), ISS< or =15 group 30 cases (62.5%) and mCTAS> or =3 group 27 cases (56.2%). However, 56.2% (27/59) of the patients were appropriately transported according to need for admission or an operation. The more severely injured patients classified by TS, ISS, and mCTAS were more appropriately transported to a tertiary center (p<0.05).
CONCLUSION
Many patients with minor injuries were transported to a tertiary center from the scene directly. The TS can be easily calculated by an emergency medical technician at the scene. Thus, we propose the TS as a useful triage tool for determining the necessity of transport to a tertiary center by helicopter.; Summary

Treatment of Atlantoaxial Fractures: Sung Chul Jin, Sang Jin Kim; J Korean Soc Traumatol. 2006;19(2):164-172.

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Abstract PDF: BACKGROUND
The authors conducted a retrospective study to evaluate the mechanism of injury, the surgical techniques, the clinical features, the combined injuries, the treatment results, and the surgical complications in patients with atlantoaxial fracture/subluxations.
METHODS
The authors reviewed 71 cervical fracture/dislocations during a four-year period from September 2002 to August 2006. Among them, there were twenty one C1,2 fracture/subluxations. There were thirteen men (mean age: 43.5 years) and eight women (mean age: 50 years). Their follow-up period was at least 6 months, and the mean follow-up period was 9.6 months. Gardner-Wells tongs traction was used in all patients immediately on presentation. Surgical treatment was performed, depending on the pathologic conditions.
RESULTS
Of all 21 cases, 14 cases were injured in motor vehicle accidents, 5 were falls, and 2 were miscellaneous. There were four C1 fracture (5.6%), fourteen C2 fracture (66.7%), one C1 and 2 combined fracture (4.8%), and one C1-2 subluxation (4.8%). The C1 fractures in our series were classified as two Jefferson's fractures and two C1 lateral mass fracture. The C2 fractures were classified as one odontoid type I fracture, two odontoid type II fractures, five odontoid type III fractures, one hangman's fracture, and four C2 body tear-drop fractures. Atlantoaxial fractures were associated with six (28.6%) head injuries, four (19.0%) other spinal injuries, two (9.5%) chest injuries, and three (14.3%) spinal cord injuries. Surgical treatment was performed in nine cases, which included anterior odontoid screw fixation in two cases, transarticular screw fixation with iliac bone graft in one case, posterior fixation by using C2 pedicle screw and C3 lateral mass screw in three cases, lateral mass screw fixation C1-2 with iliac bone graft in one case, O(occipito)-C1-3-4 screw fixation in one case, posterior C2-3 wiring with allograft in one case, and halo vest in six cases. Conservative management was used in the rest of the patients in our trials. Bone fusion was complete in all cases. There were no operation-related complication, except one pin site infection in the case of halo vest.
CONCLUSION
In this study, the choice of appropriate treatment according to the fracture types resulted in safe and effective management of unique atlantoaxial fracture/subluxations.; Summary

Case Reports

Two Cases of Chemical Burns by Hydrofluoric Acid: Sung Won Jang, You Dong Sohn, Myung Don Ju, Woo Ik Choi; J Korean Soc Traumatol. 2006;19(2):173-177.

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Abstract PDF: Hydrofluoric acid is a colorless gas or fuming liquid with a strong, irritating odor. Hydrofluoric acid burns are uncommon; however, if severe burn occur, they caused death from systemic effects, such as fatal cardiac arrthmia. We experienced two cases of hydrofluoric acid chemical burns on digits. These patients had typical clinical features of hydrofluoric acid chemical burns, such as pulsating pain at the burn site, as well as ischemic and necrotic skin changes. The hydrofluoric acid chemical burn was confirmed by a history of exposure. Subsequently, we made a calcium gluconate gel by mixing 20% calcium gluconate, an antagonist against hydrofluoric acid, with lubricant, and we injected 10% calcium gluconate subcutaneously when they complained of pain rated at higher than 5 on the pain scale. Simultaneously, we monitored the patients' electrocardiographs and checked their serum total calcium, ionized calcium, and magnesium levels serially. Clinical presentations and the emergency management of hydrofluoric acid chemical burns were reviewed along with the current literature. These patients were discharged without any significant complications.; Summary

A Fatal Intracerebral Hemorrhage Complicated by Compartment Syndrome of the Upper Arm: In Bo Han, Young Sun Chung, Dong Eun Shin, Ryoong Huh, Sang Sup Chung, Jung Yong Ahn; J Korean Soc Traumatol. 2006;19(2):178-182.

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Abstract PDF: Compartment syndrome has a wide spectrum from muscle pain to a life-threatening condition, such as acute renal failure and disseminated intravascular coagulation (DIC). Intracerebral hemorrhage (ICH) due to compartment syndrome has not been reported. We report a patient who presented with ICH leading to death. A 25-year-old female with no significant past history developed extensive compartment syndrome followed by rhabdomyolysis, acute renal failure, DIC, and ICH. Although the patient underwent a fasciotomy and hemodialysis and received aggressive resuscitation with massive transfusions of blood and intravenous fluids, she died. This case stresses the importance of early diagnosis and prompt treatment of compartment syndrome to prevent devastating complications.; Summary

A Case of Thoraco-abdominal Penetrating Injury with an Scaffolding Pipe following a Falling: Bong Jun Yang, Jae Myung Yu, Chin Seung Kim, Kwang Chan Lee, Jin Chul Ko; J Korean Soc Traumatol. 2006;19(2):183-187.

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Abstract PDF: An increase has been see in fall injuries at construction sites and in penetrating injuries by iron bars or pipes associated with the fall. In particular, a thoraco-abdominal penetrating injury had the worse prognosis, and multiple organ injury occurred because of blunt trauma associated with fall. Iron bars were the most common penetrating materials, and pipe penetrating injuries were uncommon. However, because the diameter of the pipes were large than those of the bars, penetrating injuries associated with pipes were more often fatal. A secondary thoraco-abdominal injury worsened the prognosis. We reported a case of a 33-year-old man with a thoraco-abdominal trauma secondary to a penetrating injury with a scaffolding pipe following a fall.; Summary

A Case of Tricuspid Regurgitation after Blunt Chest Trauma: Gi Hun Choi, Jeong Yeol Seo, Moo Eob Ahn, Hee Cheol Ahn, Sung Eun Kim, Seung Hwan Cheun, Seung Yong Lee, Kwang Min Choi, Hyung Soo Kim, Jae Bong Chung, Jun Hwi Cho, Joong Bum Mun, Chan Woo Park; J Korean Soc Traumatol. 2006;19(2):188-191.

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Abstract PDF: Tricuspid regurgitation after blunt chest trauma is rarely seen in the emergency department. A 19-year-old patient visited our emergency department with chest discomfort after collision with his brother while skiing. Recently, Skiing as a winter sports has become popular with the Korean people, so there is an increasing tendency for patients with diverse traumas associated with ski accidents to visit the emergency department. From simple abrasions or contusions to deadly injuries with unstable vital signs, we are seeing many kind of injuries in the emergency department. We present the case report of a patient with tricuspid regurgitation after a blunt chest trauma during the skiing.; Summary

Artery to Collecting System Communication after Abdominal Trauma: Chang Ug Lee, O Jung Kwon, Sung Hak Bang, Nak Young Choi, Chang Sub Lee, Seung Hyun Ahn; J Korean Soc Traumatol. 2006;19(2):192-195.

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Abstract PDF: Degenerative vascular disease, previous arterial surgery, long-term ureteral stenting, pelvis surgery, and radiotheraphy are reported as causes of artery-to-collecting-system communication.. Artery-to-collecting-system- communication associated with blunt trauma is rare, but potentially fatal. The diagnosis is very difficult and requires a high degree of suspicion. We were able to make the diagnosis based on the characteristic finding of contrast-enhanced computed tomography (CT) obtained in the early phase, equivalent to the finding obtained in the corticomedullary phase of the kidney. We report a case of artery to collecting system communication due to blunt abdominal trauma following a fall, which was treated by embolization.; Summary

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