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Original Articles
Factors associated with the injury severity of falls from a similar height and features of the injury site in Korea: a retrospective study
Dae Hyun Kim, Jae-Hyug Woo, Yang Bin Jeon, Jin-Seong Cho, Jae Ho Jang, Jea Yeon Choi, Woo Sung Choi
J Trauma Inj. 2023;36(3):187-195.   Published online November 16, 2022
DOI: https://doi.org/10.20408/jti.2022.0042
  • 1,963 View
  • 68 Download
AbstractAbstract PDF
Purpose
This study aimed to determine the risk factors associated with the severity of fall-related injuries among patients who suffered a fall from similar heights and analyze differences in injury sites according to intentionality and injury severity.
Methods
The Emergency Department-Based Injury In-depth Surveillance data collected between 2019 and 2020 were used in this retrospective study. Patients with fall-related injuries who fell from a height of ≥6 and <9 m were included. Patients were categorized into the severe and mild/moderate groups according to their excessive mortality ratio-adjusted Injury Severity Score (EMR-ISS) and the intention and non-intention groups. Injury-related and outcome-related factors were compared between the groups.
Results
In total, 33,046 patients sustained fall-related injuries. Among them, 543 were enrolled for analysis. A total of 256 and 287 patients were included in the severe and mild/moderate groups, respectively, and 93 and 450 patients were included in the intention and non-intention groups, respectively. The median age was 50 years (range, 39–60 years) and 45 years (range, 27–56 years) in the severe and mild/moderate groups, respectively (P<0.001). In multivariable analysis, higher height (odds ratio [OR] 1.638; 95% confidence interval [Cl], 1.279–2.098) and accompanying foot injury (OR, 0.466; 95% CI, 0.263–0.828) were independently associated with injury severity (EMR-ISS ≥25) and intentionality of fall (OR, 0.722; 95% CI, 0.418–1.248) was not associated with injury severity. The incidence of forearm injuries was four (4.3%) and 58 cases (12.9%, P=0.018) and that of foot injuries was 20 (21.5%) and 54 cases (12.0%, P=0.015) in the intention versus non-intention groups, respectively.
Conclusions
Among patients who fell from a similar height, age, and fall height were associated with severe fall-related injuries. Intentionality was not related to injury severity, and patients with foot injury were less likely to experience serious injuries. Injuries in the lower and upper extremities were more common in intentional and unintentional falls, respectively.
Summary
Exchange Nailing for Aseptic Nonunion of the Femoral Shaft after Intramedullary Nailing
Sung-Soo Ha, Chang-Wug Oh, Jae-Wook Jung, Joon-Woo Kim, Kyeong-Hyeon Park, Seong-Min Kim
J Trauma Inj. 2020;33(2):104-111.   Published online June 19, 2020
DOI: https://doi.org/10.20408/jti.2020.010
  • 9,331 View
  • 226 Download
  • 2 Citations
AbstractAbstract PDF
Purpose

Although exchange nailing is a standard method of treating femoral shaft nonunion, various rates of healing, ranging from 72% to 100%, have been reported. The purpose of this study was to evaluate the efficacy of exchange nailing in femoral shaft nonunion.

Methods

We retrospectively reviewed 30 cases of aseptic femoral shaft nonunion after intramedullary nailing. The mean postsurgical period of nonunion was 66.8 weeks. A nail at least 2 mm larger in diameter was selected to replace the previous nail after reaming. Distal fixation was performed using at least two interlocking screws. The success of the procedure was determined by the finding of union on simple radiographs. Possible reasons for failure were analyzed, including the location of nonunion, the type of nonunion, and the number of screws used for distal fixation.

Results

Of the 30 cases, 27 achieved primary healing with the technique of exchange nailing. The average time to achieve union was 23.1 weeks (range, 13.7–36.9 weeks). The three failures involved nonunion at the isthmic level (three of 15 cases), not at the infraisthmic level (zero of 15 cases). Of eight cases of oligotrophic nonunion, two (25%) failed to heal, and of 22 cases of hypertrophic nonunion, one (4.5%) failed to heal. Of 11 cases involving two screws at the distal fixation, two (18.2%) failed to heal, and of 19 cases involving three or more screws, one (5.3%) failed to heal. None of these findings was statistically significant.

Conclusions

Exchange nailing may enable successful healing in cases of aseptic nonunion of the femoral shaft. Although nonunion at the isthmic level, oligotrophic nonunion, and weaker distal fixation seemed to be associated with a higher chance of failure, further study is needed to confirm those findings.

Summary

Citations

Citations to this article as recorded by  
  • Intramedullary nailing as a treatment for non-unions of femoral shaft fractures after plating failure: A case series
    Ihsan Oesman, Dody Kurniawan, Anissa Feby Canintika
    International Journal of Surgery Case Reports.2023; 103: 107908.     CrossRef
  • Perioperative Radiographic Predictors of Non-Union in Infra-Isthmal Femoral Shaft Fractures after Antegrade Intramedullary Nailing: A Case–Control Study
    Wei-Cheng Hung, Chin-Jung Hsu, Abhishek Kumar, Chun-Hao Tsai, Hao-Wei Chang, Tsung-Li Lin
    Journal of Clinical Medicine.2022; 11(13): 3664.     CrossRef
Management and Outcome of Patients with Acetabular Fractures: Associated Injuries and Prognostic Factors
Do-Hyun Yeo, Jong-Keon Oh, Jae-Woo Cho, Beom-Soo Kim
J Trauma Inj. 2019;32(1):32-39.   Published online March 31, 2019
DOI: https://doi.org/10.20408/jti.2018.016
  • 4,086 View
  • 79 Download
  • 2 Citations
AbstractAbstract PDF
Purpose

The aim of this study was to determine which factors contribute to the surgical treatment outcomes of acetabular fractures. Simultaneously, we aim to report on the treatment results after our hospital was designated as the focused training center for trauma.

Methods

We conducted a retrospective review of all patients who experienced acetabular fractures from January 1, 2014 to May 1, 2017 and visited our hospital. Patients who had associated pelvic ring fractures or were lost to the one-year follow-up were excluded; a total of 37 fractures were evaluated. We evaluated the clinical results using the scoring system of Merle d’Aubign? (MDA) and grade of Brooker for heterotopic ossification.

Results

Thirty-seven patients (31 men and 6 women) were identified. The mean injury severity score (ISS) was 8.7, with 32.4% of patients having a score >15. The average blood transfusion in the first 24 hours was 0.54 pints. Falling was the most common injury mechanism (32.4%). Chest injury was the most common associated injury (16.2%), followed by head injury (13.5%). The posterior wall and both column fracture were the most common (37.8%) fracture patterns. Excellent and good clinical grades of MDA included 28 patients (75.6%) and fair and poor grades included nine (24.3%), respectively. Four patients were diagnosed with a post-operative infection (10.8%); one out of four patients who had co-morbidity died (2.7%), and another patient underwent a replacement surgery (2.7%). Multivariate analysis showed that age and operation time were associated with MDA. In addition, operation time and ISS were significant co-factors of the Brooker grade.

Conclusions

Korea University Guro Hospital showed similar treatment results of acetabular fractures compared to other publications. The age and operation time were co-factors of the clinical outcome of this fracture. Additionally, increased operation time and injury severity score were suggested to increase the Brooker grade.

Summary

Citations

Citations to this article as recorded by  
  • Outcome of acetabulum fractures treated with open reduction and internal fixation through Kocher-Langenbeck Approach: A retrospective study
    Dharmendra Kumar, Narendra Singh Kushwaha, Prakash Gaurav Tiwari, Yashvardhan Sharma, R.N. Srivastava, Vineet Sharma
    Journal of Clinical Orthopaedics and Trauma.2021; 23: 101599.     CrossRef
  • FUNCTIONAL AND RADIOLOGICAL OUTCOMES OF ACETABULAR FRACTURES
    Sangam Jain, Dishit Vaghasia, Tanay Nahatkar, Spandan Koshire, Amol Salve, Vinod Kumar Yadav
    INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH.2021; : 1.     CrossRef
Treatment Outcomes of Traumatic Duodenal Injury
Byunghyuk Yu, Jayun Cho, Kyoung Hoon Lim, Jinyoung Park
J Trauma Inj. 2015;28(3):129-133.   Published online September 30, 2015
DOI: https://doi.org/10.20408/jti.2015.28.3.129
  • 1,944 View
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AbstractAbstract PDF
PURPOSE
The purpose of this study is to evaluate the surgical outcome of duodenal injuries and to analyze the risk factors related to the leakage after surgical treatment.
METHODS
A retrospective review of 31 patients with duodenal injuries who managed by surgical treatment was conducted from December 2000 to May 2014. The demographic characteristics, injury mechanism, site of duodenal injury, association of intraabdominal organ injuries, injury severity score (ISS), abdominal abbreviated injury scale (AIS), injury-operation time lag, surgical treatment methods, complications, and mortality were reviewed.
RESULTS
Duodenal injury was more common in male. Twenty four (77.4%) patients were injured by blunt trauma. The most common injury site was in the second portion of the duodenum (n=19, 58.6%). Fourteen patients (45.2%) had other associated intraabdominal organ injuries. The mean ISS is 13.6+/-9.6. The mean AIS is 8.9+/-6.5. Eighteen patients (58.1%) were treated by primary closure. The remaining 13 patients underwent various operations, including exploratory laparotomy (n=4), pancreaticoduodenectomy (n=3), pyloric exclusion (n=3), Resection with end-to-end anastomosis (n=2), and duodenojejunostomy (n=1). Most common postoperative complications were intraabdominal abscess (n=9) and renal failure (n=9). Mortality rate was 9.7%.
CONCLUSION
ISS, AIS>10, operative time, pancreaticoduodenectomy, sepsis, and renal failure are significant predictors of a postoperative leak after duodenal injury. Careful management is needed to prevent a potential leak in patient with these findings.
Summary
The Risk of Cervical Spine Injuries among Submersion Patients in River
Suk Hwan Kim, Kyung Ho Choi, Se Min Choi, Young Min Oh, Jin Sook Seo, Mi Jin Lee, Kyu Nam Park, Won Jae Lee
J Korean Soc Traumatol. 2006;19(1):47-53.
  • 2,442 View
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AbstractAbstract PDF
PURPOSE
Recently, the American Heart Association recommended that routine cervical spine protection in submerged patients was not necessary, except in high-energy injury situations. However, until now, this recommendation has few supportive studies and literatures. This retrospective study was performed to demonstrate the risk of cervical spine injury in patients who had been submerged in a river.
METHODS
Seventy-nine submerged patients who visited St. Mary's Hospital between January 2000 and December 2005 were included in this retrospective study. We investigated and analyzed the victim's age, sex, activity on submersion, mental status and level of severity at admission, prognosis at discharge, associated injuries, and risk group by using the medical records and cervical spine lateral images. According to the activity on submersion, victims were classified into three groups: high risk, low risk, and unknown risk. The reports of radiologic studies were classified into unstable fracture, stable fracture, sprain, degenerative change, and normal.
RESULTS
The patients'mean age was 36.8 yrs, and 54% were males. Of the 79 patients, adult and adolescent populations (80%) were dominant. Jumping from a high bridge (48%) was the most common activity on submersion and accounted for 52% of the high-risk group. The Glasgow coma scale at admission and the cerebral performance scale at discharge showed bimodal patterns. The results of the radiologic studies showed one stable fracture, one suspicious stable fracture, and 18 sprains. The incidence of cervical spine fracture in submerged patients was 2.5% in our study. The incidence of cervical spine injury was higher in the high-risk group than it was in the low-risk group, especially in the jumping-from-high-bridge subgroup; however this observation was not statistically significant. No other factors had any significant effect on the incidence of cervical spine injury.
CONCLUSION
Our study showed that even submerged patients in the high risk group had a low incidence of cervical spine fracture and that the prognosis of a patient did not seem to be influenced by the cervical spine fracture itself.
Summary
Clinical Outcomes and Risk Factors of Traumatic Pancreatic Injuries
Hong Tae Lee, Jae Il Kim, Pyong Wha Choi, Je Hoon Park, Tae Gil Heo, Myung Soo Lee, Chul Nam Kim, Surk Hyo Chang
J Korean Soc Traumatol. 2011;24(1):1-6.
  • 1,231 View
  • 4 Download
AbstractAbstract PDF
PURPOSE
Even though traumatic pancreatic injuries occur in only 0.2% to 4% of all abdominal injuries, the morbidity and the mortality rates associated with pancreatic injuries remain high. The aim of this study was to evaluate the clinical outcomes of traumatic pancreatic injuries and to identify predictors of mortality and morbidity.
METHODS
We retrospectively reviewed the medical records of 26 consecutive patients with a pancreatic injury who underwent a laparotomy from January 2000 to December 2010. The data collected included demographic data, the mechanism of injury, the initial vital signs, the grade of pancreatic injury, the injury severity score (ISS), the revised trauma score (RTS), the Glasgow Coma Scale (GCS), the number of abbreviated injury scales (AIS), the number of associated injuries, the initial laboratory findings, the amount of blood transfusion, the type of operation, the mortality, the morbidity, and others.
RESULTS
The overall mortality rate in our series was 23.0%, and the morbidity rate was 76.9%. Twenty patients (76.9%) had associated injuries to either intra-abdominal organs or extra-abdominal organs. Two patients (7.7%) underwent external drainage, and 18 patients (69.3%) underwent a distal pancreatectomy. Pancreaticoduodenectomies were performed in 6 patients (23.0%). Three patients underwent a re-laparotomy due to anastomosis leakage or postoperative bleeding, and all patients died. The univariate analysis revealed 11 factors (amount of transfusion, AAST grade, re-laparotomy, associated duodenal injury, base excess, APACHE II score, type of operation, operation time, RTS, associated colon injury, GCS) to be significantly associated with mortality (p<0.05).
CONCLUSION
Whenever a surgeon manages a patient with traumatic pancreatic injury, the surgeon needs to consider the predictive risk factors. And, if possible, the patient should undergo a proper and meticulous, less invasive surgical procedure.
Summary
Risk factors related to progressive traumatic intracerebral hematomas in the early post head injury period
Young Bae Lee, Hwee Soo Jeong
J Korean Soc Traumatol. 2010;23(2):142-150.
  • 1,055 View
  • 2 Download
AbstractAbstract PDF
PURPOSE
In this study, patients in whom two computed tomography (CT) scans had been obtained within 24 hours of injury were analyzed to determine the incidence, risk factors and clinical significance of a progressive intracerebral hematoma (PIH).
METHODS
Participants were 182 patients with a traumatic intracerebral hematoma and contusion who underwent a repeat CT scan within 24 hours of injury. Univarite and multivariate statistics were used to define growth (volume increase) and to examine the relationship between the risk factors and hemorrhage expansion.
RESULTS
Fifty-four percent of the patients experienced progression in the size of the lesion in the initial 24 hours postinjury. A PIH was independently associated with worsened Glasgow coma scale (GCS) score (2.99, 1.04~8.60), the presence of subarachnoid hemorrhage (6.29, 2.48~16.00), the presence of a subdural hematoma (6.18, 2.13~17.98), the presence of an epidural hematoma (5.73, 1.18~27.76), and the presence of a basal cistern effacement (10.93, 1.19~99.57).
CONCLUSION
For patients undergoing scanning within 2 hours of injury, the rate of PIH approaches 61%. Early repeated CT scanning is indicated in patients with a nonsurgically-treated hemorrhage revealed on the first CT scan. Worsened GCS score, significant hematoma growth and effacement of the basal cisterns on the initial CT scan are powerful predictors of which patients will require surgery. These findings should be important factors in understanding and managing of PIH.
Summary
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.
  • 1,378 View
  • 5 Download
AbstractAbstract 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

J Trauma Inj : Journal of Trauma and Injury