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Volume 27(4); December 2014
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Original Articles
Practical Approach to the Diagnosis of Pediatric Nasal Bone Fractures
Yulkok Lee, Sungchan Oh, Sukjin Cho, Hyejin Kim, Taekyung Kang, Seungwoon Choi, Hanbin Yoo, Seokyong Ryu
J Trauma Inj. 2014;27(4):95-100.
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AbstractAbstract PDF
PURPOSE
Nasal bone fractures are the most common childhood facial bone fractures, with an incidence of about 39%. While taking a nasal bone x-ray is a common modality used in the emergency department, reports have expressed concerns with its low sensitivity and low specificity. Our study was aimed at comparing accuracy of physical and x-ray examination with that of facial bone computed tomography (CT).
METHODS
Electronic medical records (EMR) were retrospectively reviewed for patients under the age of 15 who visited our emergency department from January 2010 to December 2011with a chief complaint of nasal pain due to trauma and who had also undergone a nasal bone x-ray and facial bone CT. Patients who had not taken facial bone CT, who had been transferred, and who did not have EMR were excluded. We divided the patients into 2 groups, those who had nasal bone fractures and those without a fracture on their facial bone CT. We analyzed other parameters such as age, sex, and type of fracture to find statistical differences between the two groups.
RESULTS
A total of 209 patients were included. The patients with nasal bone fractures on their facial bone CT were older, and their traumas were more violent. Ten patients who had apparent nasal bone fractures on their facial bone CT had no definite signs of a fracture on their plain x-ray.
CONCLUSION
Though facial bone CT is an effective modality in detecting nasal bone fractures, in evaluating younger patients suspected of having nasal bone fractures, prudent use of facial bone CT is needed to reduce unnecessary exposure to radiation.
Summary
Clinical Characteristics and Prognostic Factors of Geriatric Patients Involved in Traffic Accidents
Tae Su Kim, Kang Hyun Lee, Tae Hoon Kim, O Hyun Kim, Yong Sung Cha, Kyung Chul Cha, Sung Oh Hwang
J Trauma Inj. 2014;27(4):101-107.
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AbstractAbstract PDF
PURPOSE
Recently, the population of elderly people has been increasing rapidly all over the world. The social activities of the aging population have increased, which has also increased the number of elderly patients injured in traffic accidents. Thus, we analyzed the characteristics of elderly patients involved in traffic accidents.
METHODS
This study was conducted retrospectively from July 2008 to March 2009 among trauma patients involved in traffic accidents who visited Wonju Severance Christian Hospital. Patients under 18 years of age and pregnant patients were excluded. We divided the patients in two groups, a geriatrics group and an adult group on the basis of an age of 65. We compared the types of traffic accidents, the locations of the accidents, the behaviors of the patients at the times of the accidents, the use of seat-belts, and alcohol consumption between the two groups. We calculated the Revised Trauma Score (RTS), Injury Severity Score (ISS), and Trauma and Injury Severity Score (TRISS) for each group.
RESULTS
Total number of the included patients was 903, and the number of elderly patients was 181 (mean age: 71.7+/-4.9 years old). There were no significant differences in the initial vital signs, GCS (Glasgow Coma Scale), and RTS between the two groups. There were differences in the types and the locations of the crashes, the behaviors of the patients at the times of the accidents, the use of seat belts, and alcohol consumption between the two groups (p<0.05). The average ISS of the geriatric group was higher than that of the adult group (9.66+/-10.11 vs. 6.59+/-8.99, p=0.004). The mortality was higher in the geriatric group (n=17,9%) than in the adult group (n=23,2%) (p=0.004).
CONCLUSION
The numbers of mortalities and surgical procedures were greater within the elderly group than the adult group. The average ISS was higher in the geriatric group than in the adult group. The severity of injuries due to traffic accidents was higher in the geriatric group than it was in the adult group.
Summary
Original article
The Study of the Severity and Prognosis in Severe Traumatic Patients according to Alcohol Ingestion
Ho Hyung Jung, Sang Kyoon Han, Sung Wha Lee, Sung Wook Park, Soon Chang Park, Seok Ran Yeom, Moon Gi Min, Yong In Kim, Ji Ho Ryu
J Trauma Inj. 2014;27(4):108-114.
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AbstractAbstract PDF
PURPOSE
Alcohol ingestion is a significant risk factor for injuries. However, the influence of high blood alcohol concentration about the severe traumatic injury is controversial. The aim of study was to analyze the injury severity, prognosis in severe traumatic patients according to alcohol ingestion.
METHODS
This study was performed retrospectively with severe traumatic patients (Injury Severity Score> or =16) who visited the emergency department at Pusan National University Hospital from January 2013 to December 2013.
RESULTS
In total 98 severe traumatic patients, blood alcohol concentration (BAC) positive group (BAC>30 mg/dl) is 42 (42.90%) patients and BAC negative group (BAC< or =30 mg/dl) is 56 (57.10%)patients. Head and neck injury is significantly high in BAC positive group (35 patients, 83.3%) compared to BAC negative group (33 patients, 58.9%). Comparison of injury severity, outcome and mortality is not significantly different between two groups.
CONCLUSION
In severe traumatic patients, head and neck injury occurred high in BAC positive group. Alcohol ingestion did not influence injury severity, outcome in severe traumatic patients. However, effort to decreasing injury related to alcohol ingestion and prospective multi-center study is needed.
Summary
Original Articles
Diversity of the Definition of Stable Vital Sign in Trauma Patients: Results of a Nationwide Survey
Seong Pyo Mun, Young Sun Yoo
J Trauma Inj. 2014;27(4):115-125.
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AbstractAbstract PDF
PURPOSE
Stable vital signs (SVSs) are thought to be the most important criteria for successful non-operative management (NOM) of blunt spleen injury (BSI). However, a consistent definition of SVSs has been lacking. We wanted to evaluate the diversity of the definitions of SVSs by using a nationwide survey.
METHODS
A questionnaire regarding the definition of SVSs was sent to the trauma surgeons working at the Department of Trauma Surgery and Emergency Medicine at a level-I trauma center between October 2011 and November 2011. Data were compared using analyses of the variance, t-tests, chi2 tests and logistic regressions.
RESULTS
Among 201 surgeons, 198 responded (98.2%). Of these 198 responses, 45 were incomplete, so only 153 (76.1%) were analyzed. In defining the SVSs, significant diversity existed on the subjects of type of blood pressure (BP), cut-off value for hypotension, technique for measuring BP, duration of hypotension, whether or not to use the heart rate (HR) as a determinant, cut-off value of hypotension when the patient had a comorbidity or when the patient was a child. Of the 153 surgeons whose responses were analyzed, 91.5% replied that they were confused when defining SVSs.
CONCLUSION
Confusion exists regarding how to define SVSs. Most surveyed surgeons felt that a need existed to clarify both the definition of SVSs and the use of SVSs to determine hemodynamic stability for NOM.
Summary
Measure of Agreement between Prehospital EMS Personnel and Hospital Staffs using Guidelines for Field Triage of Injured Patients
Dae Kon Kim, Ki Jeong Hong, Hyun Noh, Won Pyo Hong, Yu Jin Kim, Sang Do Shin, Ju Ok Park
J Trauma Inj. 2014;27(4):126-132.
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AbstractAbstract PDF
PURPOSE
The field trauma triage for injured patients is essential for trauma care system. In this study, agreement of patient evaluation between by prehospital EMS personnel and by hospital staffs and the appropriateness of prehospital triage were evaluated.
METHODS
This observational study was conducted from September to October 2012 for 5 weeks. During this period, EMT evaluated patient's severity according to guideline for field triage and recorded. Same guideline was applied in 26 hospitals for patients with EMS use. Kappa statistics were used to measure agreement for each item of guideline. Finally, over-triage and under-triage rate of EMT were calculated.
RESULTS
During study period, total 3,106 patients were transferred to 26 hospital emergency departments with EMS use. Kappa statistics for "vital signs" items were 0.45 for mentality lower than V and 0.44 for systolic blood pressure lower than 90 mmHg as a moderate agreement. In "anatomy of injury" items Kappa statistics were very low. In "mechanism of injury" items Kappa statistics were 0.28 for high-rise fall down and 0.27 for high energy traffic accident but in other items Kappa statistics were very low. 362 patients (12.0%) were over-triaged and 281 patients (9.3%) were under-triaged.
CONCLUSION
Field triage can be applied but need to evaluate and modify in order to become accurate and sensitive for decision of transportation.
Summary
Usefulness of End-tidal Carbon Dioxide as a Predictor of Emergency Intervention in Major Trauma Patients
Sung Ho Kim, Seunghwan Kim, Jae Gil Lee, Sung Phil Chung, Seung Ho Kim
J Trauma Inj. 2014;27(4):133-138.
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AbstractAbstract PDF
PURPOSE
If the survival of patients suffering from severe blunt trauma is to be improved, appropriate interventions should be taken immediately. The purpose of this study is to evaluate the clinical utility of end-tidal carbon dioxide (ETCO2) as a surrogate marker for predicting both the need for intervention and the prognosis.
METHODS
This is a prospective observational study. Nasal cannula was applied to measure ETCO2, and the following parameters, which are known to be related to the prognosis for a patient, were recorded: injury severity score (ISS), revised trauma score (RTS), arterial blood gas (ABG), lactate, and hemoglobin (Hb). To evaluate the outcome, we investigated the details of emergent interventions and expired patients.
RESULTS
A total of 93 patients were enrolled in this study. Emergent intervention was significantly associated with systolic blood pressure (sBP, p-value=0.001), ETCO2 (p-value<0.001), serum lactate level (p-value<0.001), pH (p-value< 0.003), HCO3 (p-value=0.004), base excess (p-value<0.002), ISS (p-value<0.001) and RTS (p-value=0.005). In the multivariate logistic regression, only ETCO2 (odds ratio (OR): 0.897, 95% confidence interval (CI): 0.792-0.975, pvalue= 0.048) and ISS (OR: 1.132, 95% CI: 1.053-1.233, p-value=0.002) were associated with emergent intervention whereas ETCO2 (p-value=0.973) and ISS (p-value=0.511) were not statistically significant in predicting the survival of patients in the univariate analysis. An optimal ETCO cut-off of 29 mmHg on the ROC curve was determined, with the area under the ROC curve (AUC) being 0.824 (0.732-0.917)].
CONCLUSION
This study has revealed that ETCO2, which can be rapid and easily measured through a nasal cannula, and the ISS may be prognostic indicators of emergent interventions in Emergency Departments.
Summary
The Utility of Ultrasonography in the Emergency Department for the Diagnosis of Finger Tendon Injury
Jung Woo Park, Jang Young Lee, Won Suck Lee, Won Young Sung, Sang Won Seo, Jung Il Yang
J Trauma Inj. 2014;27(4):139-144.
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AbstractAbstract PDF
PURPOSE
Detection and determination of tendon injury in the finger or hand is not easy. Therefore, we aimed to study and evaluate the accuracy and the effectiveness of ultrasonography for the diagnosis of finger tendon injury.
METHODS
In this study, we enrolled patients, regardless of age and sex, with lacerations on their fingers. Patients with invisible wounds were excluded. We evaluated the accuracy and the effectiveness of ultrasonography and compared the results obtained from ultrasonography and with those obtained by visual observation of the injuries.
RESULTS
The sensitivity, the specificity and the accuracy of ultrasonography were found to be 66.7%, 100% and 91.3%, respectively (p<0.001) while those of physical examination were 71.4%, 98.3% and 91.3%, respectively. Small differences were observed between the sensitivities and specificities of the two examinations; however, the accuracies were the same (p<0.001). The area under the receiver operating characteristic (ROC) curve, which was used for diagnosis of tendon rupture using ultrasonography, was found to be 0.985 (95% confidence interval CI: 0.929-0.999),while that of physical examination was 0.938 (95% CI: 0.861-0.980).
CONCLUSION
Ultrasonography can be used an effective diagnostic tool for patients with finger tendon injury.
Summary
The Role of Single-contrast CT for Management in Hemodynamically Stable Anterior Abdominal Stab wound Patients
Janghwan Jo, Joongsuck Kim, Yeongcheol Kim, Ilyong Chung, Jongmin Park, Eunjung Ahn, Eunyoung Kim, Seihyeog Park, Seongyup Kim
J Trauma Inj. 2014;27(4):145-150.
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AbstractAbstract PDF
PURPOSE
To assess the accuracy and role of single-contrast computed tomography (CT) in the management of anterior abdominal stab wound (AASW).
METHODS
During 8-years period, single-contrast CT was performed in 21 hemodynamically stable AASW patients (age range, 22-64 years; median age, 45 years), including 19 men and 2 women. CT scans were evaluated by one trauma surgeon and one senior resident to determine the depth of injury(peritoneal violation or not), and abnormal findings of intraperitoneal cavity associated with stab injury. We retrospectively reviewed medical records regarding operative findings.
RESULTS
Nine patients underwent abdominal surgery and 12 patients nonoperative management. In the abdominal surgery group, abnormal CT findings included peritoneal violation in 14 patients and abnormal intraperitoneal cavity findings in 5 patients. There was no statistical significant difference regarding abnormal CT findings between abdominal surgery group and nonoperative management group. Among the nine abdominal surgery patients, therapeutic laparotomy was performed on 4 patients. The positive predictive value (PPV) and negative predictive value (NPV) of peritoneal violation to predictive therapeutic laparotomy were 28.6% and 100%, respectively. In addition, the PPV and NPV of abnormal intraperitoneal cavity CT findings to predict therapeutic laparotomy were 40.0% and 87.5%, respectively. There was no statistical significant difference regarding the abnormal CT findings between therapeutic laparotomy group and non therapeutic laparotomy group.
CONCLUSION
CT is a good adjunctive method to evaluate hemodynamicaly stable AASW patients. If peritoneal violation is not seen on CT scan, conservative treatment on local wound may be safely performed without additional abdominal surgery. However, further study is warranted to evaluate the exact role of CT in the diagnostic workup of AASW patients.
Summary
Conversion to Internal Fixation after Temporary External Fixation for Femoral Shaft Fractures in Polytrauma Patients
Suk Kyu Choo, Kyung Woon Kang, Young Woo Kim, Hyoung Keun Oh
J Trauma Inj. 2014;27(4):151-157.
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AbstractAbstract PDF
PURPOSE
We report the surgical outcomes for femoral shaft fractures in polytrauma patients who were temporarily treated with external fixation and subsequently converted to internal fixation.
METHODS
From August 2008 to April 2012, we enrolled 13 patients with multiple traumas due to high-energy injuries and concurrent femoral shaft fractures in which temporary external fixation was carried out. The mean age was 39 years, with a range from 18 to 55 years. Ten were men and 3 were women. According to the AO/OTA classification of fractures, type A was found in 5 patients, type B in 6, and type C in 2, with open fractures being found in 6 patients and femoral artery rupture occurring in 2. For internal fixation, intramedullary nailing was performed in 7 patients, and minimally-invasive fixation of locking compression plates was used in 6.
RESULTS
Of the 7 patients converted to intramedullary nailing, 1 experienced delayed union. Of the 6 patients treated with minimally-invasive plate fixation, delayed union occurred in 5, and an auto-bone graft was performed within, on average, 8 months (range: 5~10 months), leading to bone union in all cases in the final follow-up. None of the patients experienced infections or complications involving other organs after having been converted to internal fixation. During the mean follow-up of 19 months, patients achieved satisfactory functional outcomes.
CONCLUSION
In polytrauma patients with a femoral shaft fracture who have been treated with temporary external fixation and who may need internal fixation due to the occurrence of delayed union, an appropriate internal fixation method needs to be selected based on the patient's physical status, and the fracture type.
Summary
The Effect of Acute Coagulopathy in Profoundly Traumatic Patients on Acute and Early Deaths
Minsu Noh, Song Soo Yang, Kyu Hyouck Kyoung
J Trauma Inj. 2014;27(4):158-164.
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AbstractAbstract PDF
PURPOSE
Numerous studies have investigated the pattern of traumatic death with a focus on the injury mechanism, the severity of the injury and the presence of hemorrhage. Acute coagulopathy has been treated as only one of many complications. The purpose of this study was to investigate the influence of acute coagulopathy on acute and early death due to trauma.
METHODS
A retrospective analysis of trauma patients with injury severity score (ISS)> or =25 who had been treated between January 2011 and December 2012 was conducted. Based on the time of injury, traumatic death was categorized into acute (within 48 hours) and early (from 3 to 7 days). The correlations between various parameters within 24 hours after injury and time of death were analyzed.
RESULTS
A total of 124 patients were enrolled. Of them, 8.1% (n=10) of the patients experienced acute mortality. For those patients, significant differences in initial systolic blood pressure, coagulopathy score, amount of transfusion, abbreviated injury scale of the head and neck, the abdomen and the extremities were noted. Early mortality was experienced by 7.0% (n=8) of the patients, only coagulopathy score was found to be a significant independent risk factor for acute (odds ratio: 3.127; 95% confidence interval: 1.185-8.252; p=0.021) and early mortality (odds ratio: 2.470; 95% confidence interval: 1.029-5.929; p=0.043).
CONCLUSION
Acute traumatic coagulopathy has an important role in the mortality, even after the acute phase. Early management and prevention of acute coagulopathy may improve survival of trauma patients.
Summary
Survey of Recognition of Trauma and Trauma Care System
Il Yong Chung, Joongsuck Kim, Yeongcheol Kim, Seongyup Kim
J Trauma Inj. 2014;27(4):165-169.
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AbstractAbstract PDF
PURPOSE
Trauma is one of the most common and lethal causes of death in Korea, especially in people under the age of 40. However, a considerable percentage of trauma patients are lost each year due to the scarce resources of the trauma system. The purpose of this study was to determine the recognition of trauma and trauma system.
METHODS
From April 8th to 22nd, 2014, visitors and in-patients in our medical center were interviewed and surveyed with a questionnaire, which included 28 questions regarding the trauma system, such as the most common cause of death, the locations of trauma centers, the importance of trauma centers, and consent for supporting trauma centers financially.
RESULTS
The majority of the respondents recognized trauma as a common cause of death; this was particularly true for people younger than 40. Most respondents' expectancy for the optimal time for trauma patient transport was high, recognizing that major trauma patients should receive urgent care. The respondents felt that trauma centers are important and needed, just as much as police stations and libraries are. Among 178 respondents, 140 (80.5%) were willing to financially support the trauma system.
CONCLUSION
The respondents were aware of the seriousness of trauma and generally agreed on the need for trauma centers. In order to meet the needs and the demands of the people, and to reduce preventable death rate, the trauma system should be improved not only in quality but also in quantity with better and more facilities and manpower, with the aid of publicity from trauma organizations and funding from the government.
Summary
Three-year Analysis of Patients and Treatment Experiences in the Regional Trauma Center of Gachon University Gil Hospital between 2011 and 2013
Yong Cheol Yoon, Jung Nam Lee, Min Chung, Yang Bin Jeon, Jae Jeong Park, Byung Chul Yu, Gil Jae Lee, Hyun Jin Cho, Dae Sung Ma, Min A Lee, Jung Ju Choi, Seong Son
J Trauma Inj. 2014;27(4):170-177.
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AbstractAbstract PDF
PURPOSE
The first regional trauma center selected in Korea was the Gachon University Gil hospital regional trauma center; expectation on its role has been high because of its location in the Seoul metropolitan region. To determine if those expectations are being met, we analyzed the patients visiting the center and their treatment experiences for the past 3 years in order to propose a standard for the operation of a trauma center.
METHODS
The visiting route, visiting methods, performance of emergency surgery, the ward and the length of stay, the injury mechanism, the injury severity score (ISS), the department that managed the surgery, and the cause of death were analyzed for 367 patients visiting the center from its establishment in June 2011 through December 2013.
RESULTS
The mean age of the patients was 47 years (285 male and 82 female patients). A total of 187 patients directly visited the center whereas 180 were transferred to the center. Traffic accidents comprised the majority of injury mechanisms, and 178 patients underwent emergency surgery. The mean length of stay per patient was 11 days for those in the ICU and 27 days for those in a general ward. These patients occupied 4 beds in the ICU and 10 beds in the general ward per day. A total of 1.21 surgeries were performed per patient, and the mean number of surgeries performed per day was 0.49. The mean ISS was 15.91, and 183 patients (50%) had an ISS of > or =16. Thirty-one patients died; they had a mean ISS of 28.42. The most frequent cause of death was multi-organ failure. The mean number of treatment consultations during a patient's stay was 6.32. Forty-five patients (13%) were discharged from the center, and 291 (79%) were transferred to another hospital.
CONCLUSION
A systematic approach to establishing a treatment model for trauma patients, including injury mechanism, multidisciplinary treatment, and trauma surgeon intervention, is required for treating trauma patients.
Summary
Original article
Is Local Anesthesia Necessary in Ketamine Sedation for Pediatric Facial Laceration Repair?: A Double-Blind, Randomized, Controlled Study
Min Jung Ko, Jae Hyung Choi, Young Soon Cho, Jung Won Lee, Hoon Lim, Hyung Jun Moon
J Trauma Inj. 2014;27(4):178-185.
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AbstractAbstract PDF
PURPOSE
The aim of this study was to assess the clinical efficacy of combined treatment with local anesthesia and ketamine procedural sedation for pediatric facial laceration repair in the Emergency Department (ED).
METHODS
Patients aged 1 to 5 years receiving ketamine for facial laceration repair were prospectively enrolled in a double-blind, randomized, and controlled study at an ED. All patients were to receive intravenous ketamine (2 mg/kg). The local anesthesia group (LA group) received a local anesthetic along with ketamine, whereas the no local anesthesia group (NLA group) received only ketamine. The total time of sedation, the patients' movements and groans, adverse events, and the satisfaction ratings of physicians, nurses, and parents were recorded.
RESULTS
A total of 186 patients were randomized (NLA group: 90, LA group: 96). The total time of sedation (30.5 minutes for the NLA group, 32.6 minutes for the LA group; p=0.660), patients' groans (26 (28.9%) versus 23 (24.0%); 0.446) and movements (27 (30%) versus 35 (36.5%); p=0.350) was not affected by the addition of local anesthesia. Other adverse events were similar between the two groups. Also, the satisfaction ratings of physicians (median 4 for the NLA group versus 4 for the LA group (p=0.796)), nurses (2 versus 2.5 (p=0.400)), and parents (4 versus 4 (p=0.199)) were equivalent between the two groups.
CONCLUSION
In this study, we found that local anesthesia was not required along with ketamine sedation for pediatric facial laceration repair.
Summary
Original Article
Pain Relief and Associated Factors after a Kyphoplasty for Treating an Osteoporotic Vertebral Compression Fracture
Young Do Koh, Dong Jin Kim
J Trauma Inj. 2014;27(4):186-191.
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AbstractAbstract PDF
PURPOSE
The objectives of this study were to assess pain relief according to the time after kyphoplasty and to evaluate the factors affecting pain relief after kyphoplasty in the treatment of a single-level osteoporotic vertebral compression fracture.
METHODS
A retrospective review of 34 kyphoplasties for single-level osteoporotic vertebral compression fractures was performed. Pain relief was assessed by using the visual analogue scale (VAS) at preoperatively and postoperatively at 6 weeks, 3 months, and 6 months. Associated factors, including age, sex, pain duration, bone mineral density, and cement leakage, were evaluated using the patients' medical records. Statistical analyses were conducted using the paired t-test to assess pain relief and using the independent t-test and Pearson's correlation coefficient to evaluate the relationship between those factors and pain relief.
RESULTS
Preoperatively, the mean VAS score was 7.06. Postoperatively, it declined to 3.66 (p=0.001), 2.81 (p=0.001) and 2.24 (p=0.001) at 6 weeks, 3 months and 6 months, respectively. Also, statistically significant pain relief was observed during the periods from 6 weeks to 3 months (p=0.001) and from 3 months to 6 months (p=0.001). However, reduction of the VAS score showed no significant correlation with age, sex, pain duration, bone mineral density, or cement leakage (p>0.05).
CONCLUSION
Our study suggests that a kyphoplasty may be effective in osteoporotic vertebral compression fracture patients with acute pain and that after the kyphoplasty, pain is reduced remarkably for 6 weeks and then continuously for 6 months.
Summary
Case Report
Penetrating Injury to the Left Ventricle from a Fractured Rib Following Blunt Chest Trauma
Tak Hyuk Oh, Sang Cjeol Lee, Deok Heon Lee, Joon Yong Cho
J Trauma Inj. 2014;27(4):192-195.
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AbstractAbstract PDF
The perforation of a cardiac chamber by a fractured rib after blunt trauma is a rare event. Here, we report the case of patient who was referred for multiple rib fractures after a fall from a height. The patient was found to have a penetrating cardiac injury which was detected on a computed tomography chest scan. Computed tomography is a useful screening tool for victims of blunt chest trauma. Once cardiac perforation has been confirmed or is highly suspected, it is important to preserve the patient's vital signs until reaching the operating room by minimally manuplating the chest wall and permitting hypotension, which also prevents exsanguinating hemorrhage. For the same reasons, early cardiac tamponade may also improve the patient's survival.
Summary

J Trauma Inj : Journal of Trauma and Injury