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Original Article
One year of treating patients with open fractures of the lower extremity in a new military trauma center in Korea: a case series
Ji Wool Ko, Giho Moon, Jin Geun Kwon, Kyoung Eun Kim, Hankaram Jeon, Kyungwon Lee
J Trauma Inj. 2023;36(4):376-384.   Published online December 19, 2023
DOI: https://doi.org/10.20408/jti.2023.0041
  • 394 View
  • 15 Download
AbstractAbstract PDF
Purpose
The Armed Forces Trauma Center of Korea was established in April 2022. This study was conducted to report our 1-year experience of treating soldiers with open fractures of the lower extremity.
Methods
In this case series, we reviewed the medical records of 51 Korean soldiers with open fractures of the lower extremity between April 2022 and March 2023 at a trauma center. We analyzed patients with Gustilo-Anderson type II and III fractures and reported the duration of transportation, injury mechanisms, injured sites, and associated injuries. We also presented laboratory findings, surgery types, intensive care unit stays, hospital stays, rehabilitation results, and reasons for psychiatric consultation. Additionally, we described patients’ mode of transport.
Results
This study enrolled nine male patients who were between 21 and 26 years old. Six patients had type II and three had type III fractures. Transport from the accident scene to the emergency room ranged from 75 to 455 minutes, and from the emergency room to the operating room ranged from 35 to 200 minutes. Injury mechanisms included gunshot wounds, landmine explosions, grenade explosions, and entrapment by ship mooring ropes. One case had serious associated injuries (inhalation burn, open facial bone fractures, and hemopneumothorax). No cases with serious blood loss or coagulopathies were found, but most cases had a significant elevation of creatinine kinase. Two patients underwent vascular reconstruction, whereas four patients received flap surgery. After rehabilitation, six patients could walk, one patient could move their joints actively, and two patients performed active assistive movement. Eight patients were referred to the psychiatry department due to suicidal attempts and posttraumatic stress disorder.
Conclusions
This study provides insights into how to improve treatment for patients with military trauma, as well as medical services such as the transport system, by revising treatment protocols and systematizing treatment.
Summary
Case Report
Inhalation injury after a landmine explosion: a case report
Woojung Kim, Donghoon Kim, Sung Yub Jeong, Yoonhyun Lee, Hojun Lee
J Trauma Inj. 2022;35(Suppl 1):S35-S39.   Published online June 23, 2022
DOI: https://doi.org/10.20408/jti.2022.0005
  • 2,289 View
  • 45 Download
AbstractAbstract PDF
Blast injuries are divided into four classes, and inhalation injuries are a quaternary class of blast injuries. An inhalation injury can be critical to the patient due to the possibility of related complications, such as airway obstruction resulting from upper airway edema and pneumonia. Once diagnosed, an inhalation injury should be treated with early intubation, aerosol therapy, and antibiotics as soon as possible. We should suspect this injury in circumstances involving fire and especially bomb attacks in a military setting. Antipersonnel landmines designed to damage the soldier by amputating the leg can cause blast injuries, but their power is limited to the lower extremity. However, we found an inhalation injury in a victim whose leg had been amputated by an antipersonnel landmine. As soon as we suspected an inhalation injury, we intubated the patient to preserve his airway and started acetylcysteine/heparin aerosol therapy. The patient also was treated with proper antibiotics for right lower lung pneumonia that developed as a sequela of inhalation injury. We could extubate the patient without any complications such as airway obstruction on the third day of intensive care, after which the patient was transferred to the general ward for active rehabilitation. This report presents the first known case of inhalation injury due to a landmine explosion.
Summary
Review Article
Trauma Surgery and War: A Historical Perspective
Kun Hwang
J Trauma Inj. 2021;34(4):219-224.   Published online September 7, 2021
DOI: https://doi.org/10.20408/jti.2021.0029
  • 4,188 View
  • 148 Download
  • 1 Citations
AbstractAbstract PDF

The aim of this review is to introduce the progress in trauma surgery made during war. In the 16th century, Paré reintroduced ligature of arteries, which had been introduced by Celsus and Galen, instead of cauterization during amputation. Larrey, a surgeon in Napoleon’s military, adapted the “flying artillery” to serve as “flying ambulances” for rapid transport of the wounded. He established rules for the triage of war casualties, treating wounded soldiers according to the seriousness of their injuries and the urgency of medical care. To treat fractures and tuberculosis, Thomas created the “Thomas splint”, which was used to stabilize fractured femurs and prevent infection; in World War I (WWI), use of this splint reduced the mortality of compound femur fractures from 87% to less than 8%. During WWI, Cushing systematized the treatment of head injuries, reducing mortality among head injury patients. Gillies repaired facial injuries, and his experiences became the basis of craniofacial and aesthetic surgery. In WWII, McIndoe discovered that immersion in saline promoted burn healing and improved survival rates, and thus began saline baths and early grafting instead of using tannic acid. A high mortality rate in patients with acute renal failure was noted in WWII and the Korean War. In the Korean War, Teschan used the Kolff-Brigham dialyzer. The first use of medevac with helicopters was the evacuation of three British pilot combat casualties by the US Army in Burma during WWII. As a lotus blooms in the mud, military surgeons have contributed to trauma surgery during wartime.

Summary

Citations

Citations to this article as recorded by  
  • New horizons of Flaubert: from a barber-surgeon to a modern trauma surgeon
    Kun Hwang
    Journal of Trauma and Injury.2022; 35(Suppl 1): S1.     CrossRef
Original Articles
Epidemiology and Incidence of Orthopedic Fractures in the Military of the Republic of Korea
Sung Jin An, Sang Hyun Lee, Gi-Ho Moon
J Trauma Inj. 2021;34(1):50-56.   Published online November 30, 2020
DOI: https://doi.org/10.20408/jti.2020.0046
  • 3,241 View
  • 83 Download
  • 1 Citations
AbstractAbstract PDF
Purpose

Fractures are common in the military population, but limited studies have investigated the incidence of fractures among Korean military personnel. Hence, this study aimed to clarify this issue.

Methods

Eligible subjects were patients who had sustained a fracture and were registered in the N-DEMIS (the medical records system of participating hospitals) from June 2017 to May 2019. Fractures were categorized according to the fracture site, patients’ age, sex, and type of duty.

Results

In total, 23,687 patients with 23,981 fractures were included. There were 216 patients with multiple fractures, of whom 156 had fractures at two sites, 42 had fractures at three sites, and 18 had fractures at four sites. Of the 23,687 patients, 23,340 were men and 347 were women. The incidence of fractures in men and women was 12.96 per 1,000 person-years and 0.19 per 1,000 person-years, respectively. In terms of the broad location of fractures, the percentage of fractures was the highest in the hand, followed by the foot and lower leg. When the location of fractures was analyzed more specifically, the percentage of fractures was the highest in the phalanx (thumb and fingers), followed by the ankle and metacarpal bones.

Conclusions

Hand, foot, ankle, and wrist fractures were the most commonly encountered fractures in the Korean military population. To prevent the loss of combat power due to non-battle-related injuries, thorough preparation is necessary, including protective equipment and preliminary training for areas with a high frequency of fracture occurrence.

Summary

Citations

Citations to this article as recorded by  
  • Systematic Review and Meta-analysis of Exercise for the Prevention of Musculoskeletal Injuries in Soldiers
    Hoyong Sung, Geon Hui Kim, On Lee, Jaewoo Kim, Kyoung Bae Kim, Hyo Youl Moon, Yeon Soo Kim
    The Korean Journal of Sports Medicine.2024; 42(1): 1.     CrossRef
Epidemiologic Analysis of Burns in Military Hospital
Jangkyu Choi, Sejin Park, Hyun Chul Kim
J Trauma Inj. 2017;30(4):145-157.   Published online December 30, 2017
DOI: https://doi.org/10.20408/jti.2017.30.4.145
  • 3,832 View
  • 39 Download
  • 1 Citations
AbstractAbstract PDF
Purpose

We accessed epidemioloy of 908 acute burns (7 years) in the military, of injuries and propose proper educational programs to suit community.

Methods

We surveyed burn demographics, circumstances of injuries, size, result of treatment.

Results

The mean age was 20.6 years. The flame burns (FB) (325, 35.8%) were most common, followed scald (SB) (305, 33.6%), contact (CB) (219, 24.1%), electric (EB) (45, 5.0%) and chemical burns (ChB) (14, 1.5%). The more occurred during winter (29.7%). SB had mean 3.9% total body surface area (TBSA). The 251 (82.3%) had superficial burns by spillage of hot water/food on lower limbs (45.6%), feet (33.8%) in summer (34.8%), treated with simple dressing (92.8%). Morbidity rate was 5.6%; post traumatic stress disease (PTSD) (0.7%). FB had large wound (9.3% TBSA). The 209 (64.3%) had superficial burns by ignition to flammable oils (31.7%) and bomb powders (29.2%) on head/neck (60.3%), hands (58.6%) in summer (31.7%), autumn (30.2%). They underwent simple dressing (83.4%) and skin graft (16.0%). Morbidity rate was 18.8%; PTSD (10.5%), inhalation injuries (4.0%), corneal injury (3.7%), amputations (0.9%), and mortality rate (1.2%). CB had small (1.1% TBSA), deep burns (78.5%) by hotpack (80.4%) on lower limbs (80.4%). The more (59.8%) underwent skin graft. EB had 6.8% TBSA. The 29 (64.4%) had superficial burns by touching to high tension cable (71.1%) on hand (71.1%), upper limbs (24.4%) in autumn (46.8%). They underwent simple dressing (71.1%) and skin graft (24.4%). They showed high morbidity rate (40.0%); loss of consciousness (13.3%), nerve injuries (11.1%), neuropathy (8.9%), amputations (2.2%), and mortality rate (2.2%).

Conclusions

The cook should wear apron over the boots during work. The lighter or smoking should be strictly prohibited during work with flammable liquids or bomb powders. Don’t directly apply hotpack to skin for a long time. Use insulating glove during electric work. Keep to the basic can prevent severe injury and proper education is important.

Summary

Citations

Citations to this article as recorded by  
  • The Immune and Regenerative Response to Burn Injury
    Matthew Burgess, Franklin Valdera, David Varon, Esko Kankuri, Kristo Nuutila
    Cells.2022; 11(19): 3073.     CrossRef
Qualitative Analysis of the Tetanus Antibody in Korean Army personnel after Visiting a Tertiary Armed Forces Hospital
Chung Kwon Kim, Jong Hwan Shin
J Korean Soc Traumatol. 2007;20(2):65-71.
  • 1,090 View
  • 4 Download
AbstractAbstract PDF
PURPOSE
In the Korean armed forces, vaccination against tetanus is done when personnel join the military service, but we do not know how many military personnel are vaccinated and how many soldiers have protection against tetanus. We performed a qualitative analysis of the tetanus antibody in Korean military personnel by using the TQS (Tetanus Quick Stick) METHODS: This study used a prospective collection method for military personnel visiting to the emergency department of a tertiary armed forces hospital from July 2005 to January 2007. We performed an analysis by using the TQS and asked whether the personnel had been inoculated during military service.
RESULTS
The number of enrolled military personnel was 474. Among them, 412 had been vaccinated against tetanus after entering the military service. The positive rate of TQS was 91.3% (373 patients) after vaccination for tetanus.
CONCLUSION
Many military personnel were inoculated with tetanus toxoid during military service and have protective antibodies for tetanus. According as TQS should be used for military personnel who visit the emergency department of an armed forces hospital. Also, anti-tetanus immunoglobulin should not normally be used a positive TQS for tetanus prophylaxis.
Summary

J Trauma Inj : Journal of Trauma and Injury