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Original Articles
Chest wall injury fracture patterns are associated with different mechanisms of injury: a retrospective review study in the United States
Jennifer M. Brewer, Owen P. Karsmarski, Jeremy Fridling, T. Russell Hill, Chasen J Greig, Sarah Posillico, Carol McGuiness, Erin McLaughlin, Stephanie C. Montgomery, Manuel Moutinho, Ronald Gross, Evert A. Eriksson, Andrew R. Doben
Received September 23, 2024  Accepted October 18, 2023  Published online February 23, 2024  
DOI: https://doi.org/10.20408/jti.2023.0065    [Epub ahead of print]
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AbstractAbstract PDF
Purpose
Research on rib fracture management has exponentially increased. Predicting fracture patterns based on the mechanism of injury (MOI) and other possible correlations may improve resource allocation and injury prevention strategies. The Chest Injury International Database (CIID) is the largest prospective repository of the operative and nonoperative management of patients with severe chest wall trauma. The purpose of this study was to determine whether the MOI is associated with the resulting rib fracture patterns. We hypothesized that specific MOIs would be associated with distinct rib fracture patterns.
Methods
The CIID was queried to analyze fracture patterns based on the MOI. Patients were stratified by MOI: falls, motor vehicle collisions (MVCs), motorcycle collisions (MCCs), automobile-pedestrian collisions, and bicycle collisions. Fracture locations, associated injuries, and patient-specific variables were recorded. Heat maps were created to display the fracture incidence by rib location.
Results
The study cohort consisted of 1,121 patients with a median RibScore of 2 (0–3) and 9,353 fractures. The average age was 57±20 years, and 64% of patients were male. By MOI, the number of patients and fractures were as follows: falls (474 patients, 3,360 fractures), MVCs (353 patients, 3,268 fractures), MCCs (165 patients, 1,505 fractures), automobile-pedestrian collisions (70 patients, 713 fractures), and bicycle collisions (59 patients, 507 fractures). The most commonly injured rib was the sixth rib, and the most common fracture location was lateral. Statistically significant differences in the location and patterns of fractures were identified comparing each MOI, except for MCCs versus bicycle collisions.
Conclusions
Different mechanisms of injury result in distinct rib fracture patterns. These different patterns should be considered in the workup and management of patients with thoracic injuries. Given these significant differences, future studies should account for both fracture location and the MOI to better define what populations benefit from surgical versus nonoperative management.
Summary
Traumatic degloving injuries: a prospective study to assess injury patterns, management, and outcomes at a single center in northern India
Divij Jayant, Atul Parashar, Ramesh Sharma
J Trauma Inj. 2023;36(4):385-392.   Published online November 17, 2023
DOI: https://doi.org/10.20408/jti.2023.0032
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AbstractAbstract PDF
Purpose
This study investigated the epidemiology, management, outcomes, and postoperative disabilities of degloving soft tissue injuries (DSTIs) treated at a tertiary care center in northern India.
Methods
A prospective study of patients with DSTIs was conducted over 15 months. The type of degloving injury, the mechanism of injury, and any associated injuries were analyzed using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 along with the management, outcomes, and disabilities at a 3-month follow-up.
Results
Among 75 patients with DSTIs, the average age was 27.5 years, 80.0% were male, and 76.0% had been injured in traffic accidents. The majority (93.3%) were open degloving injuries. Lower limbs were affected most often (62.7%), followed by upper limbs (32.0%). Fractures were the most commonly associated injuries (72.0%). Most patients required multiple procedures, including secondary debridement (41.3%), split skin grafting (80.0%), flap coverage (12.0%), or vacuum-assisted closure (24.0%), while five patients underwent conservative management for closed degloving injuries. Postoperative complications included surgical site infections (14.7%) and skin necrosis (10.7%). Two patients died due to septic shock and multiple organ dysfunction syndrome. The mean length of hospital stay was 11.5±8.1 days, with injuries affecting the lower limbs and perineum requiring longer hospital stays. The mean WHODAS 2.0 disability score at 3 months was 19. Most patients had mild disabilities. Time away from work depended largely upon the site and severity of the injury. Approximately 75% of patients resumed their previous job or study, 14% changed their job, and 8% stopped working completely due to residual disability.
Conclusions
Closed degloving injuries may be missed in the primary survey, necessitating a high index of suspicion, thorough clinical examination, and protocol-based management. Primary preventive strategies (e.g., road safety protocols, preplacement training, and proper protective equipment in industries) are also needed to reduce the incidence of these injuries.
Summary
Case Reports
Bleeding control of an injury to the infrarenal inferior vena cava and right external iliac vein by ipsilateral internal iliac artery and superficial femoral vein ligation after blunt abdominal trauma in Korea: a case report
Hoonsung Park, Maru Kim, Dae Sang Lee, Tae Hwa Hong, Doo-Hun Kim, Hang joo Cho
J Trauma Inj. 2023;36(4):441-446.   Published online November 17, 2023
DOI: https://doi.org/10.20408/jti.2023.0019
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AbstractAbstract PDF
Inferior vena cava (IVC) injuries, while accounting for fewer than 0.5% of blunt abdominal trauma cases, are among the most difficult to manage. Despite advancements in prehospital care, transportation, operative techniques, and perioperative management, the mortality rate for IVC injuries has remained at 20% to 66% for several decades. Furthermore, 30% to 50% of patients with IVC injuries succumb during the prehospital phase. A 65-year-old male patient, who had been struck in the back by a 500-kg excavator shovel at a construction site, was transported to a regional trauma center. Injuries to the right side of the infrarenal IVC and the right external iliac vein (EIV) were suspected, along with fractures to the right iliac bone and sacrum. The injury to the right side of the infrarenal IVC wall was repaired, and the right internal iliac artery was ligated. However, persistent bleeding around the right EIV was observed, and we were unable to achieve proximal and distal control of the right EIV. Attempts at prolonged manual compression were unsuccessful. To decrease venous return, we ligated the right superficial femoral vein. This reduced the amount of bleeding, enabling us to secure the surgical field. We ultimately controlled the bleeding, and approximately 5 L of blood products were infused intraoperatively. A second-look operation was performed 2 days later, by which time most of the bleeding sites had ceased. Orthopedic surgeons then took over the operation, performing closed reduction and external fixation. Five days later, the patient underwent definitive fixation and was transferred for rehabilitation on postoperative day 22.
Summary
Successful nonoperative management of a simultaneous high-grade splenic injury and devascularized kidney in Australia: a case report
Peter Thanh Tam Nguyen, Jeremy M. Hsu
J Trauma Inj. 2023;36(4):431-434.   Published online September 7, 2023
DOI: https://doi.org/10.20408/jti.2023.0017
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AbstractAbstract PDF
Severe blunt injuries to isolated solid abdominal viscera have been previously managed nonoperatively; however, management algorithms for simultaneous visceral injuries are less well defined. We report a polytrauma case of a 33-year-old man involved in a motorbike collision who presented with left-sided chest and abdominal pain. Initial imaging demonstrated multiple solid organ injuries with American Association for the Surgery of Trauma (AAST) grade V splenic injury and complete devascularization of the left kidney. The patient underwent urgent angioembolic coiling of the distal splenic artery with successful nonoperative management of simultaneous grade V solid organ injuries.
Summary
Penetrating chest trauma from a “less lethal” bean bag in the United States: a case report
Gloria Sanin, Gabriel Cambronero, Megan E. Lundy, William T. Terzian, Martin D. Avery, Samuel P. Carmichael II, Maggie Bosley
J Trauma Inj. 2023;36(4):421-424.   Published online September 5, 2023
DOI: https://doi.org/10.20408/jti.2023.0021
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AbstractAbstract PDF
This case report presents the case of a 49-year-old man who presented to our level I trauma center after sustaining injuries in an altercation with local law enforcement in which he was shot with a less lethal bean bag and tased. In a primary survey, a penetrating left supraclavicular wound was noted in addition to a taser dart lodged in his flank. No other traumatic findings were noted in a secondary survey. Given hemodynamic stability, completion imaging was obtained, revealing a foreign body in the left lung, a left open clavicle fracture, a C5 tubercle fracture, a possible grade I left vertebral injury, and a left first rib fracture. Soft tissue gas was seen around the left subclavian and axillary arteries, although no definitive arterial injury was identified. The bean bag projectile was embedded in the parenchyma of the left lung on cross-sectional imaging. The patient underwent thoracotomy for removal of the projectile and hemostasis. A thoracotomy was chosen as the operative approach due to concerns about significant bleeding upon foreign body removal. A chest tube was placed and subsequently removed on postoperative day 5. The patient was discharged on postoperative day 7. At a 2-week outpatient follow-up visit, the patient was doing well. This case report is the first to describe this outcome for a drag-stabilized bean bag. Although law enforcement officers utilize bean bag projectiles as a “less lethal” means of crowd control and protection, these ballistics pose significant risk and can result in serious injury.
Summary
Rare complication of skin necrosis after endoscopic debridement and cutaneo-fascial suture for a massive Morel-Lavallée lesion in Korea: a case report
Youngmin Kim, Jayun Cho, Myung Jin Jang, Kang Kook Choi
J Trauma Inj. 2023;36(3):304-309.   Published online August 25, 2023
DOI: https://doi.org/10.20408/jti.2023.0007
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AbstractAbstract PDF
A Morel-Lavallée lesion (MLL) is a pathologic fluid collection within an abnormally formed space, resulting from an internal degloving injury between the muscle fascia and subcutaneous fat layer. Due to its resistance to conservative treatments such as drainage or compression dressing, various therapeutic methods have been developed for MLL. However, no standardized guidelines currently exist. Recently, endoscopic debridement and cutaneo-fascial suture (EDCS) has been introduced for the treatment of MLL, particularly for large lesions resistant to conservative approaches. While this procedure is known to be effective, limited reports are available on potential complications. The authors present a case of skin necrosis following EDCS for a massive MLL.
Summary
Blunt abdominal trauma resulting in pancreatic injury in a pediatric patient in Australia: a case report
Harmanjit Dev, Colin Kikiros
J Trauma Inj. 2023;36(3):310-314.   Published online August 24, 2023
DOI: https://doi.org/10.20408/jti.2023.0013
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AbstractAbstract PDF
Pancreatic trauma from a blunt injury is fairly uncommon in the pediatric population. Furthermore, such trauma with associated disruption of the pancreatic duct (PD) is even less prevalent and is associated with high morbidity and mortality. Pancreatic injuries in the pediatric population are often missed and hence require a thorough workup in children presenting with any form of abdominal injury. This case report describes a young boy who presented with abdominal pain and did not initially inform medical staff about any injury. For this reason, his initial provisional diagnosis was appendicitis, but he was later found to have transection of the pancreas with injury to the PD on imaging. The management of such injuries in pediatric patients often poses a challenge due to a lack of pediatric physicians trained to perform interventions such as endoscopic retrograde cholangiopancreatography. Furthermore, such interventions carry a higher risk when performed on children due to the smaller size of their pancreatic ducts. As a result, our patient had to be transferred to an adult center to undergo this procedure. Thus, maintaining a high degree of suspicion, along with a detailed history and examination, is crucial for the early diagnosis and management of pancreatic injuries.
Summary
Successful minimally invasive management using transcatheter arterial embolization in a hemodynamically stable elderly patient with mesenteric vascular injury in a hybrid emergency room system in Korea: a case report
So Ra Ahn, Joo Hyun Lee, Sang Hyun Seo, Chan Yong Park
J Trauma Inj. 2023;36(4):435-440.   Published online July 25, 2023
DOI: https://doi.org/10.20408/jti.2023.0018
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AbstractAbstract PDF
Mesenteric injury occurs rarely in cases associated with blunt abdominal trauma. Despite its low incidence, mesenteric injury can lead to fatal outcomes such as hypovolemic shock due to hemoperitoneum or sepsis due to intestinal ischemia, or perforation-related peritonitis. For mesenteric injuries, especially those involving massive bleeding, intestinal ischemia, and perforation, the standard treatment is surgery. However, in the case of operative management, it should be borne in mind that there is a possibility of complications and mortality during and after surgery. The usefulness of transcatheter arterial embolization (TAE) is well known in solid organs but is controversial for mesenteric injury. We present a 75-year-old man with mesenteric injury due to blunt abdominal trauma. Initial abdominal computed tomography showed no hemoperitoneum, but a mesenteric contusion and pseudoaneurysm with a diameter of 17 mm were observed near the origin of the superior mesenteric artery. Since there were no findings requiring emergency surgery such as free air or intestinal ischemia, it was decided to perform nonoperative management with TAE using microcoils in hybrid emergency room system. TAE was performed successfully, and there were no complications such as bleeding, bowel ischemia, or delayed bowel perforation. He was discharged on the 23rd day after admission with percutaneous catheter drainage for drainage of mesenteric hematoma. The authors believe that treatment with TAE for highly selected elderly patients with mesenteric injuries has the positive aspect of minimally invasive management, considering the burden of general anesthesia and the various avoidable intraoperative and postoperative complications.
Summary
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
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AbstractAbstract 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.
Summary
Thoraco-laparotomy approach to salvage a life-threatening cardiac box stab injury to the infecrior vena cava in Malaysia: a case report
Ida Arinah Mahadi, Jih Huei Tan, Jin Zhe Teh, Yuzaidi Mohamad, Imran Alwi Rizal
J Trauma Inj. 2023;36(3):286-289.   Published online May 19, 2023
DOI: https://doi.org/10.20408/jti.2022.0071
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AbstractAbstract PDFSupplementary Material
Torso stab injuries near the cardiac box may present unique challenges due to difficulties in hemorrhage control. For a stab injury to the heart, the repair is straightforwardly performed via median sternotomy. In contrast, injuries to the inferior vena cava are challenging to repair, especially when they are close to the diaphragm, and the bleeding can be torrential. Herein, we describe a case of a self-inflicted stab wound within the "cardiac box." The trajectory of the stab injuries went below the diaphragm and injured the infradiaphragmatic inferior vena cava. Successful emergent repair via the thoraco-laparotomy approach revived the young man. In this report, we revisit and discuss previous large series of patients with this rare vena cava injury.
Summary
Penetrating right ventricular injury following a single gunshot to the left flank in Iraq: a case report
Zryan Salar Majeed, Yad N. Othman, Razhan K. Ali
J Trauma Inj. 2023;36(3):253-257.   Published online April 19, 2023
DOI: https://doi.org/10.20408/jti.2022.0073
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AbstractAbstract PDF
A century ago, cardiac injuries usually resulted in death. However, despite all the advances in medicine, these injuries still have high mortality and morbidity rates. In the present case, we describe a patient with a bullet injury to the right ventricle who survived at our hospital despite the limitations of our center with regard to modalities and equipment. A 30-year-old man was brought to our emergency department with a bullet wound to his left flank. He was hemodynamically unstable. After only 8 minutes in the hospital and without further investigations he was rushed to the operating room. During laparotomy, a clot was visible in the left diaphragm, which dislodged and caused extensive bleeding. The decision was made to perform a sternotomy in the absence of a sternal saw. An oblique 8-cm injury to the right ventricle was discovered following rapid exploration. It was repaired without the need for cardiopulmonary bypass surgery. After a few days in the hospital, the patient was discharged home. In the event of a penetrating cardiac injury, rapid decision-making is crucial for survival. Whenever possible, the patient should be transferred to the operating room, as emergency department thoracotomies are associated with a high mortality rate.
Summary
Original Article
The practicality of interleukin-6 in prognosis of blunt chest trauma in Korea: a retrospective study
Jeong Woo Oh, Tae Yeon Lee, Minjeong Chae
J Trauma Inj. 2023;36(2):114-120.   Published online December 8, 2022
DOI: https://doi.org/10.20408/jti.2022.0050
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AbstractAbstract PDF
Purpose
There are many studies on the practicality of interleukin-6 (IL-6) as a prognostic predictor in patients with multiple severe traumas. However, few studies focus on the practicality of IL-6 in patients with chest trauma. So, this study investigated whether IL-6 is effective as a prognostic factor in patients with blunt chest trauma.
Methods
A total of 44 blunt chest trauma patients who visited the regional trauma center from July to December 2021 were included in this retrospective study. Blood IL-6 levels were measured immediately after emergency room admittance (IL-6 E) and 24 hours after trauma (IL-6 24). To determine whether IL-6 levels can predict the clinical course and prognosis of patients with blunt chest trauma, the correlation between IL-6 (IL-6 E and IL-6 24) and the trauma score system, Injury Severity Score, Thoracic Trauma Severity Score, and Pulmonary Contusion Score, intensive care unit (ICU) stay period, and total hospitalization period were analyzed.
Results
IL-6 E showed a good correlation with Injury Severity Score (P=0.505), Thoracic Trauma Severity Score (P=0.597), Pulmonary Contusion Score (P=0.493), ICU stay period (P=0.762), and total hospitalization period (P=0.662). However, IL-6 24 had a relatively low correlation compared to IL-6 E. Therefore, IL-6 E showed useful results for predicting the prognosis of patients with blunt chest trauma.
Conclusions
Early plasma IL-6 levels (IL-6 E) can predict the injury severity of blunt chest trauma, length of ICU stay, and total hospitalization period.
Summary
Case Reports
Pancreaticoduodenectomy as an option for treating a hemodynamically unstable traumatic pancreatic head injury with a pelvic bone fracture in Korea: a case report
Sung Yub Jeong, Yoonhyun Lee, Hojun Lee
J Trauma Inj. 2023;36(3):261-264.   Published online December 7, 2022
DOI: https://doi.org/10.20408/jti.2022.0059
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AbstractAbstract PDF
Pancreatic trauma occurs in 0.2% of patients with blunt trauma and 5% of severe abdominal injuries, which are associated with high mortality rates (up to 60%). Traumatic pancreatoduodenectomy (PD) has significant morbidity and appreciable mortality owing to complicating factors, associated injuries, and shock. The initial reconstruction in patients with severe pancreatic injuries aggravates their status by causing hypothermia, coagulopathy, and acidosis, which increase the risk for early mortality. A staging operation in which PD follows damage control surgery is a good option for hemodynamically unstable patients. We report the case of a patient who was treated by staging PD for an injured pancreatic head.
Summary
External iliac artery injury with posterior pelvic ring injury in Korea: a report of two cases
Joosuk Ahn, Ji Wan Kim
J Trauma Inj. 2023;36(2):137-141.   Published online December 1, 2022
DOI: https://doi.org/10.20408/jti.2022.0046
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AbstractAbstract PDF
Pelvic ring injuries associated with external iliac artery injuries are rare and may be life-threatening condition. The most important factors in the managements are the immediate bleeding control and restoration of distal blood flow. We report two cases of pelvic ring injuries with external artery injuries. One case was occlusion of external iliac artery with concomitant rupture of internal iliac artery. The other case was ruptured external iliac artery. Every surgeon must understand the possibility of hidden lesions—for example, arterial rupture and thrombus—and should consider the need for embolization or thrombectomy when treating this type of injury.
Summary
Original Article
Changes in incidence and severity of commercial motorcycle accidents due to the use of delivery service platforms in Korea: a retrospective cohort study
Dam Moon, Jae Ho Jang, Jin Seong Cho, Jae Yeon Choi, Jae-hyug Woo, Woo Sung Choi, Sung Yeol Hyun, Seung Hwan Lee
J Trauma Inj. 2023;36(2):121-127.   Published online September 19, 2022
DOI: https://doi.org/10.20408/jti.2022.0031
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AbstractAbstract PDF
Purpose
Recently, a sharp increase in the use of delivery services has led to an increase in motorcycle accidents. This study aimed to identify the characteristics of the commercial motorcycle injured patients and factors related to the severity during the past 10 years.
Methods
Patients (15–64 years old) who visited the emergency department with commercial motorcycle accidents injury registered in the Korean Emergency Department-based Injury In-depth Surveillance (2011–2020) database, were included. All included cases were categorized into two groups according to the period: group 1 (2011–2015) and group 2 (2016–2020). General characteristics and the factors associated with severity were investigated.
Results
Among 8,123 emergency department visits, patients in group 1 were 3,071, and patients in group 2 were 5,052. The odds for severity were affected by patients age (odds ratio [OR], 1.008; 95% confidence interval [CI], 1.004–1.013), and overnight/morning (00:00–12:00; OR, 1.243; 95% CI, 1.091–1.415). The odds for severity were higher in head and neck injury (OR, 8.357; 95% CI, 7.410–9.424) and torso injury (OR, 4.122; 95% CI, 3.610–4.708). The odds for the severity of accidents based on excess mortality ratio-adjusted Injury Severity Score (EMR-ISS) after 2015 were significant (OR, 1.491; 95% CI, 1.318–1.687). Hospitalization in the intensive care unit and death were associated with accidents after 2015 (OR, 2.593; 95% CI, 2.120–3.170).
Conclusions
Commercial motorcycle accidents have increased significantly over the past decade. There were statistical differences in severity based on EMR-ISS and the hospitalization in intensive care unit and death.
Summary

J Trauma Inj : Journal of Trauma and Injury