Journal of Trauma and Injury

Original Article

A decade of treating traumatic sternal fractures in a single-center experience in Korea: a retrospective cohort study: Na Hyeon Lee, Seon Hee Kim, Jae Hun Kim, Ho Hyun Kim, Sang Bong Lee, Chan Ik Park, Gil Hwan Kim, Dong Yeon Ryu, Sun Hyun Kim; J Trauma Inj. 2023;36(4):362-368. Published online November 30, 2023; DOI: https://doi.org/10.20408/jti.2023.0027

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Purpose
Clinical reports on treatment outcomes of sternal fractures are lacking. This study details the clinical features, treatment approaches, and outcomes related to traumatic sternal fractures over a 10-year period at a single institution.
Methods
A retrospective cohort study was conducted of patients admitted to a regional trauma center between January 2012 and December 2021. Among 7,918 patients with chest injuries, 266 were diagnosed with traumatic sternal fractures. Patient data were collected, including demographics, injury mechanisms, severity, associated injuries, sternal fracture characteristics, hospital stay duration, mortality, respiratory complications, and surgical details. Surgical indications encompassed emergency cases involving intrathoracic injuries, unstable fractures, severe dislocations, flail chest, malunion, and persistent high-grade pain.
Results
Of 266 patients with traumatic sternal fractures, 260 were included; 98 underwent surgical treatment for sternal fractures, while 162 were managed conservatively. Surgical indications ranged from intrathoracic organ or blood vessel injuries necessitating thoracotomy to unstable fractures with severe dislocations. Factors influencing surgical treatment included flail motion and rib fracture. The median length of intensive care unit stay was 5.4 days (interquartile range [IQR], 1.5–18.0 days) for the nonsurgery group and 8.6 days (IQR, 3.3–23.6 days) for the surgery group. The median length of hospital stay was 20.9 days (IQR, 9.3–48.3 days) for the nonsurgery group and 27.5 days (IQR, 17.0 to 58.0 days) for the surgery group. The between-group differences were not statistically significant. Surgical interventions were successful, with stable bone union and minimal complications. Flail motion in the presence of rib fracture was a crucial consideration for surgical intervention.
Conclusions
Surgical treatment recommendations for sternal fractures vary based on flail chest presence, displacement degree, and rib fracture. Surgery is recommended for patients with offset-type sternal fractures with rib and segmental sternal fractures. Surgical intervention led to stable bone union and minimal complications.

Summary

Citations

Citations to this article as recorded by

Sternal Fracture Management
Bracken A. Armstrong, Steven M. Lorch, Jose J. Diaz
Current Problems in Surgery.2025; : 101725. CrossRef
Monitoring and Outcomes of Central Line-Associated Bloodstream Infections in a Tertiary Care Intensive Care Unit
Peter B Kharduit, Kaustuv Dutta, Clarissa J Lyngdoh, Prithwis Bhattacharyya, Valarie Lyngdoh, Annie B Khyriem, Suriya K Devi
Cureus.2024;[Epub] CrossRef

Case Reports

Iatrogenic Delayed Aortic Injury Following a Surgical Stabilization of Flail Chest: Junepill Seok, Hyun Min Cho, Seon Hee Kim, Ho Hyun Kim; J Trauma Inj. 2018;31(3):174-176. Published online December 31, 2018; DOI: https://doi.org/10.20408/jti.2018.037

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Abstract PDF

Most of aortic injuries after blunt chest trauma usually occur at the aortic isthmus and are identified in the emergency department soon after arrival. Delayed aortic injures by fractured posterior ribs, however, are relatively rare and have been reported only a few times. We recently experienced an iatrogenic descending aortic injury sustained as a result of a direct puncture by a sharp rib end after surgical stabilization of rib fractures.

Summary

Citations

Citations to this article as recorded by

Surgical Stabilisation of Traumatic Rib Fractures with Chronic, Residual Type A Aortic Dissection
Kieran J. Matic, Rajkumar Cheluvappa, Selwyn Selvendran
Healthcare.2021; 9(4): 392. CrossRef

Rectus Sheath Hematoma Caused by Noncontact Strenuous Exercise: Gil Hwan Kim, Jae Hun Kim, Ho Hyun Kim; J Trauma Inj. 2017;30(4):227-230. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.227

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Abstract PDF: Rectus sheath hematoma (RSH) is an uncommon but well-documented clinical condition. It is usually caused by direct trauma or anticoagulation, although there are many other causes. However, RSH after noncontact strenuous exercise is very rare. We present a rare case of RSH after playing volleyball without direct trauma that was successfully treated by angiographic embolization.; Summary

Successful TAE after DCS for Active Arterial Bleeding from Blunt Hepatic Injury in a Child: A Case Report: Chan Ik Park, Sang Bong Lee, Kwang Hee Yeo, Seungchan Lee, Sung Jin Park, Ho Hyun Kim, Jae Hun Kim, Chang Won Kim, Chan Yong Park; J Trauma Inj. 2016;29(2):47-50. Published online June 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.2.47

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Abstract PDF

Transcatheter arterial embolization (TAE) for blunt hepatic injury in children is not common and is especially rare after damage control surgery (DCS). We report a successful TAE after DCS on a child for massive bleeding from the left hepatic artery due to a motor vehicle accident. The car (a sport utility vehicle) ran over the chest and abdomen of a 4-year-old boy. On arrival, initial vital signs were as follows: blood pressure, 70/40 mmHg; heart rate, 149/min; temperature, 36.7℃; respiratory rate, 38/min. After resuscitation, computed tomography was done, and a suspicious contrast leakage from a branch of the left hepatic artery and a spleen injury (grade V) were found. TAE was performed successfully after DCS for a liver injury.

Summary

Citations

Citations to this article as recorded by

Damage Control Surgery for Abdominal Compartment Syndrome Caused by Delayed Rupture of Hepatic Subcapsular Hematoma
Chan Yong Park, Kwang Hee Yeo, Ho Hyun Kim, Seon Hee Kim, Hyun Min Cho, Hoon Kwon, Chang Ho Jeon, Chang Won Kim, Seok Ran Yeom
Trauma Image and Procedure.2017; 2(1): 17. CrossRef

Original Article

PARK Index for Preventable Major Trauma Death Rate: Chan Yong Park, Byungchul Yu, Ho Hyun Kim, Jung Joo Hwang, Jungnam Lee, Hyun Min Cho, Han Na Park; J Trauma Inj. 2015;28(3):115-122. Published online September 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.3.115

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Abstract PDF

PURPOSE
To calculate Preventable Trauma Death Rate (PTDR), Trauma and Injury Severity Score (TRISS) is the most utilized evaluation index of the trauma centers in South Korea. However, this method may have greater variation due to the small number of the denominator in each trauma center. Therefore, we would like to develop new indicators that can be used easily on quality improvement activities by increasing the denominator.
METHODS
The medical records of 1005 major trauma (ISS >15) patients who visited 2 regional trauma center (A center and B center) in 2014 were analyzed retrospectively. PTDR and PARK Index (Preventable Major Trauma Death Rate, PMTDR) were calculated in 731 patients with inclusion criteria. We invented PARK Index to minimize the variation of preventability of trauma death. In PTDR the denominator is all number of deaths, and in PARK Index the denominator is number of all patients who have survival probability (Ps) larger than 0.25. Numerator is the number of deaths from patients who have Ps larger than 0.25.
RESULTS
The size of denominator was 40 in A center, 49 in B center, and overall 89 in PTDR. The size of denominator was significantly increased, and 287 (7.2-fold) in A center, 422 (8.6-fold) in B center, and overall 709 (8.0-fold) in PARK Index. PARK Index was 12.9% in A center, 8.3% in B center, and overall 10.2%.
CONCLUSION
PARK Index is calculated as a rate of mortality from all major trauma patients who have Ps larger than 0.25. PARK Index obtain an effect that denominator is increased 8.0-fold than PTDR. Therefore PARK Index is able to compensate for greater disadvantage of PTDR. PARK Index is expected to be helpful in implementing evaluation of mortality outcome and to be a new index that can be applied to a trauma center quality improvement activity.

Summary

Citations

Citations to this article as recorded by

The characteristics and clinical outcomes of trauma patients transferred by a physician-staffed helicopter emergency medical service in Korea: a retrospective study
Myung Jin Jang, Woo Sung Choi, Jung Nam Lee, Won Bin Park
Journal of Trauma and Injury.2024; 37(2): 106. CrossRef
Comparison of Outcomes at Trauma Centers versus Non-Trauma Centers for Severe Traumatic Brain Injury
Tae Seok Jeong, Dae Han Choi, Woo Kyung Kim
Journal of Korean Neurosurgical Society.2023; 66(1): 63. CrossRef
Comparison of Preventable Trauma Death Rates in Patients With Traumatic Brain Injury Before and After the Establishment of Regional Trauma Center: A Single Center Experience
Dae Han Choi, Tae Seok Jeong, Myung Jin Jang
Korean Journal of Neurotrauma.2023; 19(2): 227. CrossRef
PARK Index and S-score Can Be Good Quality Indicators for the Preventable Mortality in a Single Trauma Center
Chan Yong Park, Kyung Hag Lee, Na Yun Lee, Su Ji Kim, Hyun Min Cho, Chan Kyu Lee
Journal of Trauma and Injury.2017; 30(4): 126. CrossRef

Case Report

Penetrating Neck Trauma: A Case of Spinal Cord Injury by Embedded Scissor: Seon Hee Kim, Sun Woo Choi, Sung Jin Park, Kwang Hee Yeo, Chang Wan Kim, Sang Bong Lee, Ho Hyun Kim, Chan Yong Park, Jae Hun Kim, Jung Joo Hwang, Hyun Min Cho; J Trauma Inj. 2015;28(2):71-74. Published online June 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.2.71

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Abstract PDF: Penetrating neck trauma involving spinal cord injury is relatively uncommon, but can be life-threatening. We report a case of 59-year-old female who presented with hypotension after stab injury self-inflicted with a scissor to her neck. Although Open removal of the scissor and control of bleeding were successfully done, penetration of spinal cord resulted in a neurologic impairment.; Summary

Original Article

Abdomino-perineal Organ Injuries Caused by Cultivators: Kwang Hee Yeo, Chan Yong Park, Ho Hyun Kim, Soon Chang Park, Seok Ran Yeom; J Trauma Inj. 2015;28(2):60-66. Published online June 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.2.60

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Abstract PDF

PURPOSE
Cultivator accidents are frequent and often lead to abdomino-perineal organ injury and, if severe, to death. This study presents the clinical characteristics, outcomes, and factors associated with mortality in patients who sustained an abdomino-perineal organ injury in cultivator accidents.
METHODS
We retrospectively analyzed the records of 53 patients who visited the emergency department of a tertiary hospital with abdomino-perineal organ injuries caused in cultivator accidents from April 2005 to March 2010.
RESULTS
All 53 patients had visited other medical institutions before visiting our hospital. Their mean age was 64.0+/-11.1 (range, 20-80) years and 32 (60.4%) patients were 65 or older. The male-to-female ratio was 46:7. The chief complaint was abdominal pain (38 cases, 71.7%). The 53 patients included 41 cultivator operators (77.4%), 11 passengers (20.8%), and 1 passerby (1.9%). The causes of the injuries included a direct impact of the handlebar in 20 cases (37.7%), a rollover in 21 cases (39.6%), a fall in 10 cases (18.9%), and a wheel in two cases (3.8%). Several of the 53 patients had injuries to multiple abdomino-perineal organs, and the injured organs included the liver (23 cases, 26.4%), spleen (16 cases, 18.4%), pancreas (7 cases, 8.0%), small bowel (7 cases, 8.0%), mesentery (6 cases, 6.9%), adrenal gland (5 cases, 5.8%), and other organs. According to the abbreviated injury scale (AIS) dictionary, a thoracic injury was the most frequent co-injury (33 of 53 cases, 62.3%). Abdomino-perineal surgery was performed in 31 cases (58.8%) and angio-embolization was performed for six liver and two kidney injuries. Thirteen patients died (24.5%); all were males. The Injury Severity Scale (ISS) was lower in the survivors (17.8+/-8.5 vs. 27.0+/-16.0; p=0.010).
CONCLUSION
With the aging of agricultural workers, safety education programs should be implemented. Furthermore, the patient transfer system in agricultural areas must be improved.

Summary

Citations

Citations to this article as recorded by

Analysis of Cultivator-related Trauma Cases in a Regional Trauma Center in the Rural Area of Gyeongbuk Province
Ui Kang Hwang, Seok Hwa Youn, Chan Yong Park
Journal of Trauma and Injury.2017; 30(3): 80. CrossRef

Case Report

Successful Angiographic Embolization of Superficial Circumflex Iliac Artery Rupture Caused by Blunt Abdominal Trauma: A Case Report: Sang Bong Lee, Sung Jin Park, Kwang Hee Yeo, Ho Hyun Kim, Chan Yong Park, Jae Hun Kim, Chang Wan Kim, Seon Uoo Choi, Seon Hee Kim, Jung Joo Hwang, Hyun Min Cho; J Trauma Inj. 2015;28(1):39-42. Published online March 30, 2015; DOI: https://doi.org/10.20408/jti.2015.28.1.39

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Abstract PDF: Lat. abdominal wall hematoma with active bleeding is very rare but need prompt bleeding control. We report successful treatment by angiographic embolization of superficial circumflex iliac artery rupture caused by blunt trauma. A 60-year-old woman presented painful, enlarging, lat. abdominal wall mass with ecchymosis caused by blunt abdominal trauma. Contrast leakage of superficial circumflex iliac a. within the lt. ext. oblique m. hematoma was confirmed by abdominal computed tomography. Angiographic embolization was performed successfully. Patient was discharged at 4th day after trauma without complication. Angiographic embolization is important treatment option of lat. abdominal wall hematoma with active bleeding replacing emergency surgery.; Summary

Original Article

Surgical Management of Duodenal Traumatic Injuries: A Single Center Study: Oh Hyun Park, Yun Chul Park, Dong Gyu Lee, Ho Hyun Kim, Chan Yong Park, Jung Chul Kim; J Trauma Inj. 2013;26(3):157-162.

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Abstract PDF: PURPOSE
Abdominal trauma rarely causes injuries involving duodenum. But, it is associated with higher rate of the complication and mortality than other abdominal injuries. There are many options for the management of duodenal injuries. Herein we are to review our experiences and find out the risk factors related to the morbidity and the mortality in traumatic duodenal injuries.
METHODS
The medical records of total 25 patients who managed by surgical managements and survive more than 48 hours were conducted from January 2006 to December 2012. The clinical characteristics, treatments, and outcomes are reviewed.
RESULTS
Among 25 patients, most of them (n=17, 68.0%) were managed by the pyloric exclusion and the gastrojejunostomy. The 3rd portion is the most injured site (n=15, 60.0%), and the majority exhibited grade 2 severity (n=14, 56.0%). Most of patients had blunt abdominal traumas (n=23, 92.0%) so that many of them (n=14, 56.0%) had other combined abdominal injuries. The mean ISS is 11.5+/-6.2. The surgery related mortality rate was 28.0%. There was no statistical significance between each factors and the mortality except leakage (p=0.012). But, we could find some trends about traumatic duodenal injuries in this study. The mortality rates of them who older than 55 years were higher than others. And, all 3 patients who delayed the operation more than 24 hours after the trauma had some complications or died. Also, the patients who had the 2nd portion injury, grade 3 injury, or combined abdominal injury were less survived.
CONCLUSION
Duodenal injury is related to high rate of morbidity(47.8%) and mortality(28.0%). Age, portion of injury, OIS grade, ISS>15, combined intra-abdominal operation, and trauma to operation time over 24 hrs have some trend with attribution to mortality. Especially leakage of duodenal injury is related to mortality.; Summary

Case Reports

Cerebral Fat Embolism after Traumatic Multiple Fracture: A Case Report: Ho Hyun Kim, Yun Chul Park, Dong Kyu Lee, Chan Yong Park, Jae Hun Kim, Yeong Dae Kim, Jung Chul Kim; J Trauma Inj. 2013;26(2):58-62.

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Abstract PDF: A cerebral fat embolism is an uncommon but serious complication of long bone fracture. It can be fatal, and early detection is not easy. Neurologic symptoms are variable, and the clinical diagnosis is difficult. The pathogenesis remains controversial, and several theories have been proposed. Magnetic resonance imaging can detect a cerebral fat embolism with a higher sensitivity than cerebral computed tomography. We report a case of a post-traumatic cerebral fat embolism without pulmonary involvement and review the existing literature.; Summary

Traumatic Perforation of the Duodenal Diverticulum: A Case Report: Ho Hyun Kim, Yun Chul Park, Dong Kyu Lee, Chan Yong Park, Jae Hun Kim, Yeong Dae Kim, Jung Chul Kim; J Trauma Inj. 2013;26(2):53-57.

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Abstract PDF: A duodenal diverticulum is a frequent abnormality that is usually diagnosed incidentally. Clinical manifestations usually mimic those of highly-varied entities. Among the complications of a duodenal diverticulum, perforation is fairly rare; rupture due to blunt trauma is even rarer, and no cases have been reported in Korean literature. We report the case of a 61-year-old male patient who presented with a perforated duodenal diverticulum after a blunt trauma. We also review the existing literature.; Summary

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