Journal of Trauma and Injury

Volume 35(1); March 2022

Editorial

Adam's apple and airway obstruction: Kun Hwang; J Trauma Inj. 2022;35(1):1-2. Published online September 1, 2021; DOI: https://doi.org/10.20408/jti.2021.0040

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Original Articles

Characteristics of injuries associated with electric personal mobility devices: a nationwide cross-sectional study in South Korea: Maro Kim, Dongbum Suh, Jin Hee Lee, Hyuksool Kwon, Yujin Choi, Joo Jeong, Sola Kim, Soyun Hwang, Joong Wan Park, You Hwan Jo; J Trauma Inj. 2022;35(1):3-11. Published online October 28, 2021; DOI: https://doi.org/10.20408/jti.2021.0044

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Purpose
The increasing use of electric personal mobility devices (ePMDs) has been accompanied by an increasing incidence of associated accidents. This study aimed to investigate the characteristics of ePMD-related injuries and their associated factors. Methods: This cross-sectional study was conducted using data from the Emergency Department-based Injury In-depth Surveillance database from 2014 to 2018. All patients who were injured while operating an ePMD were eligible. The primary outcome was the rate of severe injury, defined as an excess mortality ratio-adjusted Injury Severity Score of ≥25. We calculated the adjusted odds ratios (AORs) of outcomes associated with ePMD-related injuries. Results: Of 1,391,980 injured patients, 684 (0.05%) were eligible for inclusion in this study. Their median age was 28 years old, and most injuries were sustained by men (68.0%). The rate of ePMD-related injuries increased from 3.1 injuries per 100,000 population in 2014 to 100.3 per 100,000 population in 2018. A majority of the injuries occurred on the street (32.7%). The most commonly injured area was the head and face (49.6%), and the most common diagnosis was superficial injuries or contusions (32.9%). Being aged 55 years or older (AOR=3.88; 95% confidence interval [CI] 1.33–11.36) and operating an ePMD while intoxicated (AOR=2.78; 95% CI 1.52–5.08) were associated with severe injuries. Conclusions: The number of emergency room visits due to ePMD-related injuries is increasing. Old age and drunk driving are both associated with serious injuries. Active traffic enforcement and safety regulations regarding ePMDs should be implemented to prevent severe injuries caused by ePMD-related accidents.

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Types of injuries caused by isolated electric scooter accidents
Kyongwon Yoo, Hyung Il Kim
Journal of Trauma and Injury.2022; 35(4): 232. CrossRef

Evaluation of the accuracy of mobile cone-beam computed tomography after spinal instrumentation surgery: Ki Seong Eom, Eun Sung Park, Dae Won Kim, Jong Tae Park, Kwon-Ha Yoon; J Trauma Inj. 2022;35(1):12-18. Published online December 29, 2021; DOI: https://doi.org/10.20408/jti.2021.0010

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Abstract PDF: Purpose
Pedicle screw fixation provides 3-column stabilization, multidimensional control, and a higher rate of interbody fusion. Although computed tomography (CT) is recommended for the postoperative assessment of pedicle screw fixation, its use is limited due to the radiation exposure dose. The purpose of this preliminary retrospective study was to assess the clinical usefulness of low-dose mobile cone-beam CT (CBCT) for the postoperative evaluation of pedicle screw fixation. Methods: The author retrospectively reviewed postoperative mobile CBCT images of 15 patients who underwent posterior pedicle screw fixation for spinal disease from November 2019 to April 2020. Pedicle screw placement was assessed for breaches of the bony structures. The breaches were graded based on the Heary classification. Results: The patients included 11 men and four women, and their mean age was 66±12 years. Of the 122 pedicle screws, 34 (27.9%) were inserted in the thoracic segment (from T7 to T12), 82 (67.2%) in the lumbar segment (from L1 to L5), and six (4.9%) in the first sacral segment. Although there were metal-related artifacts, the image of the screw position (according to Heary classification) after surgery could be assessed using mobile CBCT at all levels (T7–S1). Conclusions: Mobile CBCT was accurate in determining the location and integrity of the pedicle screw and identifying the surrounding bony structures. In the postoperative setting, mobile CBCT can be used as a primary modality for assessing the accuracy of pedicle screw fixation and detecting postoperative complications.; Summary

Perioperative complications of the modified Stoppa approach for the treatment of pelvic bone fractures: a single-institution review of 48 cases: Hyeonjoon Lee, Suenghwan Jo, Gwangchul Lee, Yongjin Cho; J Trauma Inj. 2022;35(1):19-24. Published online November 23, 2021; DOI: https://doi.org/10.20408/jti.2021.0061

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Purpose
The current study aimed to report the perioperative complications of the modified Stoppa approach for the treatment of pelvic bone fractures. Methods: We analyzed 48 consecutive operations in 45 patients who were treated with internal fixation using the modified Stoppa approach between March 2016 and July 2018. This included three revision operations. The mean age of the patients was 54.5 years, and the patients included 35 male patients and 10 female patients. All fractures occurred as a consequence of high-energy trauma and 70.3% had associated injuries at the time of the fracture. The mean Injury Severity Score was 9.03±5.60. The perioperative complications found during and immediately after surgery were recorded and were classified into three categories: vascular injuries, nerve injuries, and other complications. Results: Overall, 14 perioperative complications (29.2%) in 14 cases were identified. The most common complications were nerve injuries, which occurred in seven cases, all involving the obturator nerve. Uncontrollable vascular injuries occurred in six cases, which required additional incisions and support of vascular surgeons or postoperative interventions. Additionally, one case of peritoneal tearing occurred, which required help from an abdominal surgeon. Conclusions: While the modified Stoppa approach seems to be a viable method to treat pelvic fractures, significant perioperative complications may occur, suggesting that surgeons should pay careful attention to minimize the damage to other structures and that appropriate support from other surgical departments is paramount.

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Severe intraoperative vascular bleeding as main complication of acetabular fractures treated with plate osteosynthesis via the modified Stoppa approach
Julia Riemenschneider, Maren Janko, Tilmann Vollrath, Christoph Nau, Ingo Marzi
Injury.2023; 54(7): 110773. CrossRef

Validity of the scoring system for traumatic liver injury: a generalized estimating equation analysis: Kangho Lee, Dongyeon Ryu, Hohyun Kim, Chang Ho Jeon, Jae Hun Kim, Chan Yong Park, Seok Ran Yeom; J Trauma Inj. 2022;35(1):25-33. Published online September 7, 2021; DOI: https://doi.org/10.20408/jti.2021.0009

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Purpose
The scoring system for traumatic liver injury (SSTLI) was developed in 2015 to predict mortality in patients with polytraumatic liver injury. This study aimed to validate the SSTLI as a prognostic factor in patients with polytrauma and liver injury through a generalized estimating equation analysis. Methods: The medical records of 521 patients with traumatic liver injury from January 2015 to December 2019 were reviewed. The primary outcome variable was in-hospital mortality. All the risk factors were analyzed using multivariate logistic regression analysis. The SSTLI has five clinical measures (age, Injury Severity Score, serum total bilirubin level, prothrombin time, and creatinine level) chosen based on their predictive power. Each measure is scored as 0–1 (age and Injury Severity Score) or 0–3 (serum total bilirubin level, prothrombin time, and creatinine level). The SSTLI score corresponds to the total points for each item (0–11 points). Results: The areas under the curve of the SSTLI to predict mortality on post-traumatic days 0, 1, 3, and 5 were 0.736, 0.783, 0.830, and 0.824, respectively. A very good to excellent positive correlation was observed between the probability of mortality and the SSTLI score (γ=0.997, P<0.001). A value of 5 points was used as the threshold to distinguish low-risk (<5) from high-risk (≥5) patients. Multivariate analysis using the generalized estimating equation in the logistic regression model indicated that the SSTLI score was an independent predictor of mortality (odds ratio, 1.027; 95% confidence interval, 1.018–1.036; P<0.001). Conclusions: The SSTLI was verified to predict mortality in patients with polytrauma and liver injury. A score of ≥5 on the SSTLI indicated a high-risk of post-traumatic mortality.

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Liver Trauma: Management in the Emergency Setting and Medico-Legal Implications
Angela Saviano, Veronica Ojetti, Christian Zanza, Francesco Franceschi, Yaroslava Longhitano, Ermelinda Martuscelli, Aniello Maiese, Gianpietro Volonnino, Giuseppe Bertozzi, Michela Ferrara, Raffaele La Russa
Diagnostics.2022; 12(6): 1456. CrossRef

Percutaneous two unilateral iliosacral S1 screw fixation for pelvic ring injuries: a retrospective review of 38 patients: Whee Sung Son, Jae-Woo Cho, Nam-Ryeol Kim, Jun-Min Cho, Nak-Jun Choi, Jong-Keon Oh, HanJu Kim; J Trauma Inj. 2022;35(1):34-42. Published online November 3, 2021; DOI: https://doi.org/10.20408/jti.2021.0075

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Abstract PDF: Purpose
Percutaneous iliosacral (IS) screw fixation for pelvic ring injuries is a minimally invasive technique that reduces the amount of blood loss and shortens the procedure time. Moreover, two unilateral IS S1 screws exhibit superior stability to a single IS screw and are also safer for neurological injuries than an S2 screw. Therefore, this study aimed to evaluate fixation using percutaneous two unilateral IS S1 screws for pelvic ring injuries and its subsequent clinical outcomes. Methods: We retrospectively reviewed 38 patients who underwent percutaneous two unilateral IS S1 screw fixation for pelvic ring injuries. The procedure time, blood loss, achievement of bone union, radiological outcomes (Matta and Tornetta grade), and postoperative complications were evaluated. Results: The mean procedure time, hemoglobin loss, bone union rate, and time to union were 40.1 minutes (range, 18–102), 0.6 g/dL (range, 0.3–1.0), 100%, and 153.2 days (range, 61–327), respectively. The Matta and Tornetta grades were excellent, good, and fair in 24 (63.1%), 11 (28.9%), and 3 patients (7.9%), respectively, and the postoperative complications were S1 screw loosening, widening of the symphysis pubis (2.3 and 2.5 mm), lumbosacral plexopathy, and S1 radiculopathy in one (2.6%), two (5.3%), one (2.6%), and one patient (2.6%), respectively. However, all neurological complications recovered spontaneously. Conclusions: Percutaneous two unilateral IS S1 screw fixation was useful for treating pelvic ring injuries. In particular, it involved a short procedure time with little blood loss and also led to 100% bone union and good radiological outcomes.; Summary

Case Reports

Chronic epidural hematoma evacuated through surgical treatment: a case report: Eui Gyu Sin; J Trauma Inj. 2022;35(1):43-45. Published online March 21, 2022; DOI: https://doi.org/10.20408/jti.2021.0036

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Epidural hematoma (EDH) can sometimes be life-threatening, although small-volume EDHs can resolve spontaneously like other intracranial hematomas. However, in rare cases, EDH can transform into a chronic form instead of disappearing. In contrast to subdural hematoma, there is no agreed-upon definition or treatment of chronic EDH. A 41-year-old male patient with acute EDH in the bilateral paravertical area due to partial rupture of the sagittal sinus was operated first, and then remnant contralateral hematoma was treated conservatively. One month after surgery, he showed hemiparesis, and brain imaging revealed chronic EDH at the location of the remnant acute hematoma. We performed surgery again to treat chronic EDH through a large craniotomy. Although many cases of EDH are self-limited, clinicians must keep in mind that some cases of EDH, especially those of venous origin and arising in young people, can become chronic and require surgical treatment.

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Chronic epidural hematoma: a systematic review and meta-analysis
Nicaise Kpègnon Agada, Nourou Dine Adeniran Bankole, Mèhomè Wilfried Dossou, Omar Boladji Adébayo Badirou, Emeka Alfred Clement, Fresnel Lutèce Ontsi Obame, Laté Dzidoula Lawson, Romeo Bujiriri Murhega, Arsène Daniel Nyalundja, Nukunté David Lionel Togben
Egyptian Journal of Neurosurgery.2023;[Epub] CrossRef

Dual repair of traumatic flank hernia using laparoscopic and open approaches: a case report: Yoonjung Heo, Dong Hun Kim; J Trauma Inj. 2022;35(1):46-50. Published online October 25, 2021; DOI: https://doi.org/10.20408/jti.2021.0008

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Abstract PDF Supplementary Material: Traumatic flank hernia (TFH) is rare and prone to recurrence, which makes appropriate treatment challenging. No current guidelines define the optimal timing and method of repair. Meanwhile, recent advances in laparoscopic techniques are reshaping the options for the treatment of TFH. A dual approach that utilizes both laparoscopic and open methods has not previously been reported. Herein, we present the successful treatment of TFH after blunt trauma. A 46-year-old male patient underwent elective herniorrhaphy on hospital day 3, in which laparoscopic implantation of a sublay mesh and extracorporeal implantation of an onlay mesh were performed. Such techniques may be appropriate and result in feasible outcomes in hemodynamically stable patients with large TFH who are strongly suspected of having bowel herniation or concomitant intraperitoneal injuries. Larger studies are needed to assess the long-term results.; Summary

Delayed bladder perforation due to screw loosening after pelvic ring injury surgery: a case report: Hyun-Chul Shon, Ho-Won Kang, Eic-Ju Lim, Jae-Young Yang; J Trauma Inj. 2022;35(1):51-55. Published online December 22, 2021; DOI: https://doi.org/10.20408/jti.2021.0054

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Abstract PDF: Pelvic ring injuries have high mortality and morbidity rates, and they are difficult to treat because accompanying injuries to the pelvic organs, genitourinary organs, and neurovascular tissues are common. Genitourinary injuries are common comorbid injuries that have been reported to occur in 5% to 6% of all pelvic ring injuries. However, these injuries usually occur simultaneously with the pelvic ring injury, whereas relatively little research has dealt with genitourinary injuries that occur after treatment of a pelvic ring injury. To the best of our knowledge, only three cases of delayed bladder perforation due to screw loosening after symphyseal plate fixation in anterior pelvic ring injury have been reported worldwide, and no such cases have yet been reported in Korea. Since the authors experienced this very rare complication after pelvic ring surgery, we report this case along with a literature review.; Summary

Bilateral foot drop caused by T12 infectious spondylitis after vertebroplasty: a case report: Dong Hwan Kim, Yong Beom Shin, Mahnjeong Ha, Byung Chul Kim, In Ho Han, Kyoung Hyup Nam; J Trauma Inj. 2022;35(1):56-60. Published online March 21, 2022; DOI: https://doi.org/10.20408/jti.2021.0083

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The most common cause of foot drop is lumbar degenerative disc herniation, particularly at L4/5. We present a rare case of spinal cord injury accompanied by a thoracolumbar lesion that presented with bilateral foot drop. A 69-year-old male patient presented with sudden-onset severe bilateral leg pain and bilateral foot drop. Radiologic findings revealed T12 spondylitis compressing the conus medullaris. He had undergone vertebroplasty for a T12 compression fracture after a fall 6 months before. A physical examination showed bilateral foot drop, paresthesia of both L5 dermatomes, increased deep tendon reflex, and a positive Babinski sign. An acute bilateral L5 root lesion and a conus medullaris lesion were suspected based on electromyography. A surgical procedure was done for decompression and reconstruction. After the operation, bilateral lower extremity muscle strength recovered to a good grade from the trace grade, and the patient could walk without a cane. The current case is a very rare report of bilateral foot drop associated with T12 infectious spondylitis after vertebroplasty. It is essential to keep in mind that lesions of the thoracolumbar junction can cause atypical neurological symptoms. Furthermore, understanding the conus medullaris and nerve root anatomy at the T12–L1 level will be helpful for treating patients with atypical neurological symptoms.

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Evaluating Acute Bilateral Foot Drop: A Case Report
Arsh N Patel, Colby Kihara, Carter Gay, Katie Oakley, P.J. Reddy
Cureus.2022;[Epub] CrossRef

Traumatic abdominal wall hernia with hemoperitoneum caused by blunt injury: laparoscopic exploration with mini-laparotomy repair. A case report: Euisung Jeong, Hyunseok Jang, Younggoun Jo, Yunchul Park, Naa Lee, Jungchul Kim; J Trauma Inj. 2022;35(1):61-65. Published online December 23, 2021; DOI: https://doi.org/10.20408/jti.2021.0062

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Traumatic abdominal wall hernia is a very rare clinical entity. Herein, we report the case of a patient who was transferred from a local clinic to the emergency department because of left lower abdominal pain. Initially, an intra-abdominal hematoma was observed on computed tomography and no extravasation was noted. Conservative treatment was initiated, and the patient’s symptoms were slightly relieved. However, though abdominal pain was relieved during the hospital stay, bowel herniation was suspected in the left periumbilical area. Follow-up computed tomography showed traumatic abdominal wall hernia with hemoperitoneum in the abdomen. We performed a laparoscopic exploration of the injury site and hernia lesion. The anterior abdominal wall hernia was successfully closed.

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Unique laparoscopic emergency management of traumatic obstructed abdominal wall hernia: A case report and review of literature
Arwa M Aljuhani, Ghaith A Al Saied, Arjmand Reyaz, Mohammed A Alkahlan, Ibrahim M Aljohani, Muhammed M Abukhater
International Journal of Abdominal Wall and Hernia.2024;[Epub] CrossRef

Very large haematoma following the nonoperative management of a blunt splenic injury in a patient with preexisting liver cirrhosis: a case report: Euisung Jeong, Younggoun Jo, Yunchul Park, Jungchul Kim, Hyunseok Jang, Naa Lee; J Trauma Inj. 2022;35(1):66-70. Published online December 24, 2021; DOI: https://doi.org/10.20408/jti.2021.0077

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Abstract PDF: The spleen is the most commonly injured organ after blunt abdominal trauma. Nonoperative management (NOM) is the standard treatment for blunt splenic injuries in haemodynamically stable patients without peritonitis. Complications of NOM include rebleeding, new pseudoaneurysm formation, splenic abscess, and symptomatic splenic infarction. These complications hinder the NOM of patients with blunt splenic injuries. We report a case in which a large haemorrhagic fluid collection that occurred after angio-embolisation was resolved by percutaneous drainage in a patient with liver cirrhosis who experienced a blunt spleen injury.; Summary

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