Journal of Trauma and Injury

Volume 29(4); December 2016

Original Articles

The Significance of Clinical Examination for Brain Lesion Differentiation of Patients with Head Trauma after Alcohol Intoxication: Yoon Hyun Jung, Dong Kil Jeong, Jung Won Lee, Hyung Jun Moon, Jae Hyung Choi, Jun Hwan Song; J Trauma Inj. 2016;29(4):99-104. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.99

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Abstract PDF: PURPOSE
There are many patients visited to ED in an alcohol intoxicated state. For these patients, it is difficult to predict by only clinical examination whether he/she would have brain lesion. The purpose of this study is to research whether it is possible to predict brain lesion by only clinical examination findings, with comparing patients with/without actual brain lesions.
METHODS
A retrospective study was performed at a university hospital for the period 11 months with the medical records. As for the inclusion group, head trauma patients with objectively proved drunk, judging by their blood ethanol concentration, and performed the brain CT were selected. In terms of medical record, Glasgow coma scale (GCS), the presence of neurologic abnormalities, the presence of lesion on brain CT of the patients, were examined. From laboratory results, blood ethanol concentration, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT) and glucose concentration were identified.
RESULTS
For this study, there were total 80 patients of inclusion group. There was no statistically significant difference in terms of GCS score and neurological examination abnormalities, between the group with brain lesion and the group without brain lesion on brain CT.
CONCLUSION
Alcohol intoxicated patient with head trauma visits the ED, it is not possible to distinguish or determine whether brain lesion exists or not by only clinical findings. In order to check the lesion existence, the image examination, therefore, should be considered and performed.; Summary

Operative Treatment for Midshaft Clavicle Fractures in Adults: A 10-Year Study Conducted in a Korean Metropolitan Hospital: Jeong Kook Baek, Young Ho Lee, Min Bom Kim, Goo Hyun Baek; J Trauma Inj. 2016;29(4):105-115. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.105

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Abstract PDF: PURPOSE
While all midshaft clavicle fractures have traditionally been treated with conservative measures, recent operative treatment of displaced, communited midshaft clavicle fractures has become more common. Though a recent increase in operative treatment for midshaft clavicle fractures, we have done the operative methods in limited cases. The aim of this study is to present indications, operative techniques and outcomes of the experienced cases that have applied to this limited group over the previous 10 years.
METHODS
This study consists of a retrospective review of radiological and clinical data from January of 2005 to July of 2015. Operative criteria for midshaft clavicle fractures having considerable risk of bone healing process were 4 groups - a floating shoulder, an open fracture, an associated neurovascular injury, and a nonunion case after previous treatment.
RESULTS
The study consisted of 18 patients who had operative treatment for midshaft clavicle fractures in adults. The most common surgical indication was a floating shoulder (10 cases, 55.6%), followed by nonunion (5 cases, 27.8%), an associated neurovascular injury (4 cases, 22.2%), and open fracture (3 cases, 16.7%). All cases were treated by open reduction and internal fixation in anterosuperior position with reconstruction plate or locking compression plate. Bone union was achieved in all cases except 1 case which was done bone resection due to infected nonunion. Mean bone union period was 19.5 weeks. There were no postoperative complications, but still sequelae in 4 cases of brachial plexus injury.
CONCLUSION
We have conducted an open reduction and internal fixation by anterosuperior position for midshaft clavicle fractures in very limited surgical indications for last 10 years. Our treatment strategy for midshaft clavicle fractures showed favorable radiological results and low postoperative complications.; Summary

Analysis of Abdominal Trauma Patients Using National Emergency Department Information System: In Gyu Song, Jin Suk Lee, Sung Won Jung, Jong Min Park, Han Deok Yoon, Jung Tak Rhee, Sun Worl Kim, Borami Lim, So Ra Kim, Il Young Jung; J Trauma Inj. 2016;29(4):116-123. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.116

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PURPOSE
To develop an inclusive and sustainable trauma system as the assessment of burden of injuries is very much important. The purpose of this study was to evaluate the estimates and characteristics of abdominal traumatic injuries.
METHODS
The data were extracted from the National Emergency Department Information System. Based on Korean Standard Classification for Disease 6th version, which is the Korean version of International Classification of Disease 10th revision, abdominal injuries were identified and abdominal surgeries were evaluated with electronic data interchange codes. Demographic factors, numbers of surgeries and clinical outcomes were also investigated.
RESULTS
From 2011 to 2014, about 24,696 patients with abdominal trauma were admitted to the hospitals annually in South Korea. The number of patients who were admitted to regional and local emergency medical centers was 8,622 (34.91%) and 15,564(63.02%), respectively. Based on National Emergency Department Information System, liver was identified as the most commonly injured abdominal solid organ (39.50%, 9,754/24,696, followed by spleen (17.57%, 4,338/24,696) and kidney (12.94%, 3,195/24,696).
CONCLUSION
This study shows that the demand for abdominal trauma care is considerable in South Korea and most of the patients with abdominal trauma were admitted to regional or local emergency centers. The results of this study can be used as good source of information for staffs to ensure proper delivery of abdominal trauma care in trauma centers nationally.

Summary

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Abdominal stab wound in A Pregnant woman resulting in Evisceration, Uterine Perforation and Fetal Chest Injury: A Case Report and Literature Review
Oumarou O, Landry TW, Joe NC, Wirwah FT, Ulrich BS, Jean-Paul EN
Journal of Surgery and Surgical Research.2019; : 010. CrossRef

The Risk Factors for Developing Contrast-induced Nephropathy after the Evaluation of Trauma Patients at a Regional Trauma Center in Korea: Yoo Mi An, Soon Chang Park, Hyung Bin Kim, Young Mo Cho, Dae Seop Lee, Yong In Kim, Sang Kyun Han; J Trauma Inj. 2016;29(4):124-128. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.124

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Abstract PDF: PURPOSE
Computed tomography (CT) with intravenous (IV) contrast is an important step in the evaluation of trauma patients; however, the risk factors for contrast-induced nephropathy (CIN) in these patients remain unclear. This study determined the rate of CIN in trauma patients at a regional trauma center in Korea and identified the risk factors for developing CIN.
METHODS
We retrospectively reviewed the medical records of 138 patients for the patient demographics, creatinine levels, and vital signs. CIN was defined as an increase in creatinine by 0.5 mg/dL from admission after undergoing CT with IV contrast.
RESULTS
Of the patients, 7.2% developed CIN during their admission after receiving IV contrast for CT. In the multivariate analysis, only the creatinine level at presentation (Adjusted odds ratio [aOR], 5.944; 95% confidence interval [CI], 1.486-23.733; p=0.012) and an injury severity score (ISS) greater than 22 (aOR, 1.096; 95% CI, 1.021-1.176; p=0.011) were independently associated with the risk of CIN.
CONCLUSION
CIN is uncommon in trauma patients following CT with IV contrast. The creatinine level at presentation and ISS were independent risk factors for developing CIN in trauma patients.; Summary

Aseptic Humeral Nonunion: What Went Wrong? What to Do? A Retrospective Analysis of 20 Cases: Jinil Kim, Jae Woo Cho, Won Tae Cho, Jun Min Cho, Namryeol Kim, Hak Jun Kim, Jong Keon Oh, Jin Kak Kim; J Trauma Inj. 2016;29(4):129-138. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.129

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Abstract PDF: PURPOSE
Due to recent advances in internal fixation techniques, instrumentation and orthopedic implants there is an increasing number of humeral shaft fracture treated operatively. As a consequence, an increased number nonunion after operative fixation are being referred to our center. The aim of this study is to report the common error during osteosynthesis that may have led to nonunion and present a systematic analytical approach for the management of aseptic humeral shaft nonunion.
METHODS
In between January 2007 to December 2013, 20 patients with humeral shaft nonunion after operative procedure were treated according to our treatment algorithm. We could analysis x-rays of 12 patients from initial treatment to nonunion. In a subgroup of 12 patients the initial operative procedure were analyzed to determine the error that may have caused nonunion. The following questions were used to examine the cases: 1) Was the fracture biology preserved during the procedure? 2) Does the implant construct have enough stability to allow fracture healing? RESULTS: In 19 out of 20 patients have showed radiographic evidence of union on follow up. One patient has to undergo reoperation because of the technical error with bone graft placement but eventually healed. There were 2 cases wherein the treatment algorithm was not followed. All patients had problems with mechanical stability, and in 13 patients had biologic problems. In the analysis of the initial operative fixation, only one of 12 patients had biologic problems.
CONCLUSION
In our analysis, the common preventable error made during operative fixation of humeral shaft fracture is failure to provide adequate stability for bony union to occur. And with these cases we have demonstrated a systematic analytic management approach that may be used to prevent surgeons from reproducing the same fault and reduce the need for bone grafting.; Summary

The Effect of Trauma Team Approach on the Management of Hemodynamically Unstable Pelvic Bone Fracture: Retrospective Comparative study: Won Tae Cho, Jae Woo Cho, Jinil Kim, Jin Kak Kim, Jong Keon Oh, Hak Jun Kim, Namryeol Kim, Jun Min Cho; J Trauma Inj. 2016;29(4):139-145. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.139

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PURPOSE
The major pelvic trauma results in high mortality with associated fatal other injuries. During early stage of resuscitation, multidisciplinary approach is essential to improve the survival and outcomes. This study aims to report the effect and positive outcome of the trauma team approach on the management of hemodynamically unstable pelvic bone fracture.
METHODS
This retrospective review included all patients with hemodynamically unstable pelvic bone fracture admitted between March 2007 and December 2015. Patients were divided into group A, which comprised those admitted before the trauma team approach was started, and group B, which comprised those admitted after the approach was started. The advanced trauma life support protocol was followed for all patient. The comparisons between the two groups were based on medical records. Study variables included demographics, initial vital sign, injury severity score, fracture type, and injury mechanism. We analyzed the outcomes in each group with respect to the time interval for doctors' arrival, total length of stay in the emergency department (ED), time interval for computed tomography evaluation, 24-hour mortality, time interval for definitive fixation, and definitive fixation in the time-window of opportunity.
RESULTS
Fifty-three patients met the inclusion criteria. No statistically significant differences in demographic data existed between the two groups. The time interval for doctors' arrival (min, 63.09±50.48 vs 21.48±17.75; p=0.038) and total length of stay in the ED (min, 269.33±105.96 vs 115.49±56.24; p=0.023) were significantly improved. The 24-hour mortality was not significantly different between the two groups.(%, 14.3 vs 12.0; p=1.000) However, the time interval for definitive fixation and definitive fixation in the time-window of opportunity showed better results.
CONCLUSION
The trauma team approach has positive effects, which include initial resuscitation through multidisciplinary approach and shortening the time interval to definitive fixation, on the management of hemodynamically unstable pelvic bone fracture.

Summary

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The Effects of a Trauma Team Approach on the Management of Open Extremity Fractures in Polytrauma Patients: A Retrospective Comparative Study
Seungyeob Sakong, Eic Ju Lim, Jun-Min Cho, Nak-Jun Choi, Jae-Woo Cho, Jong-Keon Oh
Journal of Trauma and Injury.2021; 34(2): 105. CrossRef

Management of Thoracic Aortic Injury after Blunt Trauma: Nine Cases at a Single Medical Center: Kyungwon Lee, Jae Gil Lee; J Trauma Inj. 2016;29(4):146-150. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.146

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Traumatic aortic injuries are rare, but life threatening condition. They usually occur after high velocity impact on the chest or abdomen such as traffic accident or fall. We report the experiences of the traumatic aortic injuries at a single center.
METHODS
We retrospectively reviewed the medical records of nine patients with aortic injury resulting from the blunt trauma from Jan. 2010 to May. 2016.
RESULTS
The mean age was 51.1±20.8 years old, and ten (90.9%) were men. The mechanisms of injury were traffic accidents in seven patients (motorcycle accidents; 3, car accidents; 4), and four in fall injury. Most common injured sites were thoracic aorta (9, 81.8%). Aortic injuries were repaired by endovascular approach in four patients, and by open graft surgery in four. Two patients were managed conservatively. Nine patients survived without any complications.
CONCLUSION
We had experienced different approaches for management of aortic injuries after blunt trauma according to locations and severity of lesions.; Summary

Time to Surgery and Injury Severity Score: Chang Seon Oh, Jae Gil Lee, Seung Hyun Kim; J Trauma Inj. 2016;29(4):151-154. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.151

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Abstract PDF: PURPOSE
To evaluate the association between time to surgery and injury severity score (ISS).
METHODS
Medical charts and records were reviewed for polytrauma patients who underwent trauma surgery from November 2014 to March 2016. The patients were divided into two groups based on the ISS.
RESULTS
Among the 217 operated patients, 22 patients underwent first and second surgery. The patients with an ISS over 17 (mean 13.0 days) had a longer interval between surgeries than patients with an ISS of 17 or less (mean 7.5 days) (p=0.031). One hundred and twenty-one patients only underwent elective surgery and there is a positive correlation between ISS and time to elective surgery (p<0.028, Pearson's correlation coefficient=0.224). Seventy-four patients underwent emergent surgery only. Among these, the patients with an ISS of 17 or less underwent general surgery (86%) but the patients with an ISS more than 17 underwent neurological surgery (47%).
CONCLUSION
Patients with high ISS need critical care during the preoperative and postoperative period.; Summary

Characteristics of Korean Trauma Patients: A Single-center Analysis Using the Korea Trauma Database: Youngeun Park, Min Chung, Gil Jae Lee, Min A Lee, Jae Jeong Park, Kang Kook Choi, Sung Youl Hyun, Yang Bin Jeon, Dae Sung Ma, Yong Cheol Yoon, Jungnam Lee, Byungchul Yoo; J Trauma Inj. 2016;29(4):155-160. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.155

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PURPOSE
Two years have passed since a level I trauma center was officially opened in the Gacheon Gil Hospital, South Korea. We analyzed 2014 and 2015 registered patient data from the Korean Trauma Data Base (KTDB) to identify trends in trauma patient care and factors that influence the quality of trauma care at the Gacheon Gil trauma center.
METHODS
Data was extracted from the KTDB included patient age, sex, systolic blood pressure at emergency room arrival, revised trauma score, injury severity score, trauma injury severity score, transfusion amount, and the cause of death was analyzed.
RESULTS
A total of 3269 trauma patients were admitted to our trauma center in 2014 and 3225 in 2015. Demographics and mechanism of injury were not significantly different between years. The severity of trauma injury was decreased in 2015 although the mortality rate was slightly increased. This requires further analysis.
CONCLUSION
The aim of this study was to determine the general status and trends in trauma incidence and management outcomes for the Incheon area. We noted no significant changes in trauma status from 2014 to 2015. We need to collect and review trauma patient data over a long period in order to elucidate trauma incidence and management trends in the trauma field. Finally, studies using trauma patient data will indicate appropriate quality control factors for trauma care and help to improve the quality of trauma management.

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Associated Injuries in Spine Trauma Patients: A Single-Center Experience
Seunghan Yu, Hyuk Jin Choi, Jung Hwan Lee, Byung Chul Kim, Mahnjeong Ha, In Ho Han
Journal of Trauma and Injury.2020; 33(4): 242. CrossRef

Blush on Computed Tomography and Transcatheter Arterial Embolization in Pelvic Fracture: Jihun Gwak, Yong Cheol Yoon, Min A Lee, Byungchul Yu, Myung Jin Jang, Kang Kook Choi; J Trauma Inj. 2016;29(4):161-166. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.161

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Abstract PDF: PURPOSE
Bleeding is the primary cause of death after severe pelvic fracture. Transcatheter arterial embolization (TAE) is the mainstay of treatment for arterial bleeding. This study aimed to determine the frequency of bleeding by angiography of blush-positive pelvic fractures on computed tomography (CT) images. The bleeding arteries that were involved were investigated by pelvic angiography.
METHODS
This retrospective cohort study evaluated 83 pelvic fracture patients who were treated in the intensive care unit of the author's trauma center between January 01, 2013 and April 30, 2015.
RESULTS
Overall mortality was 9 of 83 patients (10.8%). Blush was observed in 37 patients; blush-positive patients had significantly higher mortality (24.3%) than blush-negative patients (0%). Twenty-four of the 83 patients (28.9%) underwent pelvic angiography. Bleeding was showed in 22 of 24 patients in pelvic angiography. TAE was successfully performed in 21 (95.5%) of the bleeding 22 patients. Angiography was performed in 23 of 37 blush-positive patients, and arterial bleeding was identified in 21 (91.3%). A total 33 bleeding arteries were identified in 22 angiography-positive patients. The most frequent origin of bleeding was internal iliac artery (69.7%) followed by the external iliac artery (18.2%) and lumbar arteries (12.1%).
CONCLUSION
The vascular blush observed in CT scans indicates sites of ongoing bleeding in pelvic angiography. TAE is an excellent therapeutic option for arterial bleeding and has a high success rate with few complications.; Summary

Case Reports

Arthroscopic Reduction of Irreducible Posterolateral Knee Dislocation with Interposition of the Vastus Medialis: A Case Report: Jae Ang Sim, Byung Kag Kim, Beom Koo Lee, Yong Cheol Yoon, Eun Suk Choi; J Trauma Inj. 2016;29(4):167-171. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.167

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Abstract PDF: Irreducible traumatic knee dislocation is rare. The knee dislocation is classified depending on the incarcerated structures. Complete reduction is achieved by extracting the incarcerated structure. Several reports introduce the reduction of irreducible traumatic knee dislocation by open surgery or arthroscopy. This case describes irreducible posterolateral knee dislocation with interposition of the vastus medialis. Closed reduction failed in the emergency room, and complete reduction was attained by arthroscopically sectioning the muscle and fascia of the vastus medialis in the intercondylar notch.; Summary

Stent Graft Repair of Penetrated Injury of the Common Carotid Artery: Soon Jin Kim, Sang Woo Ryu, Jaykey Chekar, Yong Tae Kim, Bo Ra Seo; J Trauma Inj. 2016;29(4):172-175. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.172

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Abstract PDF: Penetrated injury of common carotid artery (CCA) is rare and extremely lethal. Carotid artery injury tends to bleed actively and potentially occlude the trachea. It can cause fatal neurological complications. An accurate diagnosis and adequate treatment are very needed to the successful outcome of the penetrating vascular injury in zone 1, 2, and 3 of the neck. Open surgical treatment is more invasive and complicated than endovascular treatment. We experienced a case with penetrating injury in neck zone 2. Here, we report the case successfully treated with endovascular stent graft technique.; Summary

Delayed Posttraumatic Spinal Epidural Hematoma: Importance of Early Surgical Treatment for Neurologic Deficits: Deok Heon Lee, Tak Hyuk Oh, Jong Chul Lee, Kyoung Hoon Lim; J Trauma Inj. 2016;29(4):176-179. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.176

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Abstract PDF: Delayed posttraumatic spinal epidural hematoma is an extremely rare disease, and it remains a challenge for surgical teams of trauma centers. Magnetic resonance imaging is an essential tool for early diagnosis, and emergent evacuation of the hematoma is the best choice of treatment. We report the case of a 33-year old man with posttraumatic epidural hematoma in the thoracic spine (T10 and T11 levels), who developed an abrupt-onset paraplegia 5 days after the trauma.; Summary

Intraoperative Diagnosis of a Pericardial Injury Associated with Multiple Diaphragmatic Ruptures in a Patient with Abdominal Blunt Trauma: Do Wan Kim, In Seok Jeong, Kook Joo Na, Sang Yun Song, Kyo Seon Lee, Seung Ku Kang; J Trauma Inj. 2016;29(4):180-183. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.180

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Abstract PDF: A diaphragmatic injury is uncommon, but occurs more frequently with injury to other organs. Particularly, a diaphragmatic accompanied by a pericardial injury is very rare. The authors report a case of incidentally detecting a pericardial injury during surgery for a diaphragmatic injury due to abdominal blunt trauma.; Summary

Development of a Chest Wall Deformity after Conservative Treatment for a Sternal Fracture: Do Wan Kim, In Seok Jeong, Kook Joo Na, Sang Yun Song, Kyo Seon Lee, Seung Ku Kang; J Trauma Inj. 2016;29(4):184-186. Published online December 31, 2016; DOI: https://doi.org/10.20408/jti.2016.29.4.184

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Abstract PDF: Although sternal fractures are relatively common, treatment has not been clarified. Thus, the authors report a case of a patient with a sternal fracture associated with a thoracic spinal fracture who had received conservative treatment, but the outcome was not satisfactory.; Summary

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