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- Percutaneous screw fixation and external stabilization as definitive surgical intervention for a pelvic ring injury combined with an acetabular fracture in the acute phase of polytrauma in Korea: a case report
- Hohyoung Lee, Myung-Rae Cho, Suk-Kyoon Song, Euisun Yoon, Sungho Lee
- J Trauma Inj. 2023;36(3):298-303. Published online July 13, 2023
- DOI: https://doi.org/10.20408/jti.2023.0002
- 1,895 View
- 77 Download
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Abstract
PDF - Unstable pelvic ring injuries are potentially life-threatening and associated with high mortality and complication rates in polytrauma patients. The most common cause of death in patients with pelvic ring injuries is massive bleeding. With resuscitation, external fixation can be performed as a temporary stabilization procedure for hemostasis in unstable pelvic fractures. Internal fixation following temporary external fixation of the pelvic ring yields superior and more reliable stabilization. However, a time-consuming extended approach to open reduction and internal fixation of the pelvic ring is frequently precluded by an unacceptable physiologic condition and/or concomitant injuries in patients with multiple injuries. Conservative treatment may lead to pelvic ring deformity, which is associated with various functional disabilities such as limb length discrepancy, gait disturbance, and sitting intolerance. Therefore, if the patient is not expected to be suitable for additional surgery due to a poor expected physiologic condition, definitive external fixation in combination with various percutaneous screw fixations to restore the pelvic ring should be considered in the acute phase. Herein, we report a case of unstable pelvic ring injury successfully treated with definitive external fixation and percutaneous screw fixation in the acute phase in a severely injured polytrauma patient.
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- Large Focal Extrapleural Hematoma of Chest Wall: A Case Report
- Hohyoung Lee, Sung Ho Han, Min Koo Lee, Oh Sang Kwon, Kyoung Hwan Kim, Jung Suk Kim, Soon-Ho Chon, Sung Ho Shinn
- J Trauma Inj. 2019;32(2):115-117. Published online June 30, 2019
- DOI: https://doi.org/10.20408/jti.2019.001
- 5,773 View
- 54 Download
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Although hemothorax and pneumothorax are common complications seen in rib fractures, focal extrapleural hematoma is quite rare. We report a 63-year-old female patient that developed large focal extrapleural hematoma after falling off a second floor veranda. The patient had sustained 3, 4, 5th costal cartilage rib fractures and a sternum fracture. She had developed suspected empyema with loculations with small amount of hemothorax. She underwent a planned early decortication/adhesiolysis by video assisted thoracoscopic surgery at the 12th post-trauma day due to failed drainage. Unexpectedly, she had no adhesions or any significant retained hematoma mimicking a mass, but was found with the focal extrapleural chest wall hematoma. She was discharged on postoperative 46th day for other reasons and is doing fine today.
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- Bilateral Chylothorax Due to Blunt Spine Hyperextension Injury: A Case Report
- Hohyoung Lee, Sung Ho Han, Min Koo Lee, Oh Sang Kwon, Kyoung Hwan Kim, Jung Suk Kim, Soon-Ho Chon, Sung Ho Shinn
- J Trauma Inj. 2019;32(2):107-110. Published online June 30, 2019
- DOI: https://doi.org/10.20408/jti.2018.050
- 3,867 View
- 67 Download
- 1 Citations
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Abstract
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Bilateral chylothorax due to blunt trauma is extremely rare. We report a 74-year-old patient that developed delayed bilateral chylothorax after falling off a ladder. The patient had a simple 12th rib fracture and T12 lamina fracture. All other findings seemed normal. He was sent home and on the 5th day visited our emergency center at Halla Hospital with symptoms of dyspnea and lower back pain. Computer tomography of his chest presented massive fluid collection in his right pleural cavity and moderate amounts in his left pleural cavity with 12th rib fracture and T11-12 intervertebral space widening with bilateral facet fractures. Chest tubes were placed bilaterally and chylothorax through both chest tubes was discovered. Conservative treatment for 2 weeks failed, and thus, thoracic duct ligation was done by video assisted thoracoscopic surgery. Thoracic duct embolization was not an option. Postoperatively, the patient is now doing well and happy with the results. Early surgical treatment must be considered in the old patient, whom large amounts of chylothorax are present.
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Citations
Citations to this article as recorded by
- Thoracic Duct Injury
José Luis Ruiz Pier, Moheb A. Rashid
Journal of Cardiothoracic Trauma.2021; 6(1): 15. CrossRef
Original Article- Effectiveness after Designation of a Trauma Center: Experience with Operating a Trauma Team at a Private Hospital
- Kyoung Hwan Kim, Sung Ho Han, Soon-Ho Chon, Joongsuck Kim, Oh Sang Kwon, Min Koo Lee, Hohyoung Lee
- J Trauma Inj. 2019;32(1):1-7. Published online March 31, 2019
- DOI: https://doi.org/10.20408/jti.2018.054
- 3,663 View
- 44 Download
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Purpose The present study aimed to evaluate the influence of how the trauma care system applied on the management of trauma patient within the region.
Methods We divided the patients in a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in the Halla Hospital after designation of a trauma center. We compared annual general characteristics, injury severity score, the average numbers of the major trauma patients, clinical outcomes of the emergency department, and mortality rates between the two groups.
Results No significant differences were found in the annual patients’ average age (54.1±20.0 vs. 52.8±18.2,
p =0.201), transportation pathways (p =0.462), injury mechanism (p =0.486), injury severity score (22.93 vs. 23.96,p =0.877), emergency room (ER) stay in minutes (199.17 vs. 194.29,p =0.935), time to operation or procedure in minutes (154.07 vs. 142.1,p =0.767), time interval to intensive care unit (ICU) in minutes (219.54 vs. 237.13,p =0.662). The W score and Z score indicated better outcomes in post-trauma system group than in pre-trauma system group (W scores, 2.186 vs. 2.027; Z scores, 2.189 vs. 1.928). However, when analyzing survival rates for each department, in the neurosurgery department, in comparison with W score and Z score, both W score were positive and Z core was higher than +1.96. (pre-trauma group: 3.426, 2.335 vs. post-trauma group: 4.17, 1.967). In other than the neurosurgery department, W score was positive after selection, but Z score was less than +1.96, which is not a meaningful outcome of treatment (pre-trauma group: ?0.358, ?0.271 vs. post-trauma group: 1.071, 0.958).Conclusions There were significant increases in patient numbers and improvement in survival rate after the introduction of the trauma system. However, there were no remarkable change in ER stay, time to ICU admission, time interval to emergent procedure or operation, and survival rates except neurosurgery. To achieve meaningful survival rates and the result of the rise of the trauma index, we will need to secure sufficient manpower, including specialists in various surgical area as well as rapid establishment of the trauma center.
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