Journal of Trauma and Injury

Case Reports

Experience with the emergency vascular repair of upper limb arterial transection with concurrent acute compartment syndrome: two case reports: Charles Chidiebele Maduba, Ugochukwu Uzodimma Nnadozie, Victor Ifeanyichukwu Modekwe; J Trauma Inj. 2023;36(1):60-64. Published online September 7, 2022; DOI: https://doi.org/10.20408/jti.2022.0007

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Abstract PDF: Upper extremity vascular injuries occurring with acute compartment syndrome are very challenging to manage in an emergency context in resource-poor settings. The need to always recognize the likelihood of coexisting compartment syndrome guides surgeons to perform concomitant fasciotomy to ensure a better outcome. We managed three vascular injuries in the upper extremities in two patients with concomitant imminent compartment syndrome observed intraoperatively. The first injury was complete brachial artery disruption following blunt trauma, while the second and third injuries were radial and ulnar artery transection caused by sharp glass cuts. Both patients were treated with vascular repair and fasciotomy. Secondary wound coverage was applied with split-thickness skin grafting, and the outcomes were satisfactory. Concomitant fasciotomy potentially improves the outcomes of vascular repair in emergency vascular surgery and should be considered for all injuries with the potential for acute compartment syndrome.; Summary

Sphenoid sinus foreign body following airbag deployment in the United States: a case report: Birk J. Olson, Joseph B. Vella, Justin P. McCormick; J Trauma Inj. 2023;36(2):133-136. Published online August 16, 2022; DOI: https://doi.org/10.20408/jti.2022.0030

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Abstract PDF: We report a unique case of penetrating foreign bodies following a motor vehicle accident with airbag deployment. The patient presented with evidence of facial trauma and was found to have three retained foreign bodies on imaging. Notably, one foreign body was within the sphenoid sinus. This foreign body was removed uneventfully through endoscopic sinus surgery. The patient was doing well at follow-up visits. We concluded that the foreign bodies were steering wheel accessories, which detached upon airbag deployment and penetrated the patient’s face. This case report is intended to inform the public regarding the dangers of placing accessories on a steering wheel.; Summary

Repair of traumatic flank hernia with mesh strip suture: a case report: Shin Ae Lee, Ye Rim Chang; J Trauma Inj. 2022;35(Suppl 1):S46-S52. Published online August 16, 2022; DOI: https://doi.org/10.20408/jti.2022.0026

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Abstract PDF: Traumatic flank hernia is a relatively rare hernia. We report a case of a male patient with severe multiple trauma, including abdominal injury, who presented with flank hernia 3 years postinjury. The hernia was successfully repaired using mesh strips suture, and at the 12-month follow-up, no complications or recurrence was found. Our findings indicate that when it is difficult to secure a sufficient operative field for mesh anchoring in a traumatic flank hernia, a technique of sutured repair with mesh strips may be considered as a treatment option as it requires less dissection. Compared to the conventional planar mesh repair, this technique decreases the risk of injuries and ischemic necrosis of the surrounding tissues.; Summary

Original Article

The effect of neuropathic pain on quality of life, depression levels, and sleep quality in patients with combat-related extremity injuries: Merve Örücü Atar, Gizem Kılınç Kamacı, Fatma Özcan, Yasin Demir, Koray Aydemir; J Trauma Inj. 2022;35(3):202-208. Published online August 9, 2022; DOI: https://doi.org/10.20408/jti.2022.0019

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Abstract PDF: Purpose
There is limited research on the effects of neuropathic pain (NP) on quality of life, depression levels, and sleep quality in patients with combat-related extremity injuries. This study evaluated whether patients with combat-related extremity injuries with and without NP had differences in quality of life, sleep quality, and depression levels.
Methods
A total of 98 patients with combat-related extremity injuries, 52 with NP and 46 without, were included in this cross-sectional study. The presence of NP was determined using the Leeds Assessment of Neuropathic Symptoms and Signs questionnaire. The outcome measures were a visual analogue scale (VAS), the 36-Item Short Form Survey, the Beck Depression Inventory, and the Pittsburgh Sleep Quality Index (PSQI).
Results
The VAS subparameter scores for pain (all P˂0.05), PSQI sleep duration subscale scores (P=0.025), PSQI sleep disturbance subscale scores (P=0.016), and PSQI total scores (P=0.020) were significantly higher in patients with NP than those without. Logistic regression analysis showed that VAS scores of 5 and above for average pain during the previous 4 weeks contributed independently to the prediction of NP.
Conclusions
Patients with combat-related extremity injuries with NP had more pain and poorer sleep quality than those without NP. Sleep quality should be evaluated as part of the diagnostic work-up in patients with combat-related extremity injury with NP, and interventions to improve sleep quality may help manage NP in this patient group.; Summary

Case Report

Bilateral anterior dislocation in the hips: a case report: Dheeraj Makkar, Ravi Sauhta; J Trauma Inj. 2023;36(1):70-73. Published online August 5, 2022; DOI: https://doi.org/10.20408/jti.2022.0023

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Abstract PDF: The hip is a stable ball-and-socket joint. Bilateral anterior dislocations of the native hip joints account for fewer than 1% of all dislocations. We present a unique case of a bilateral anterior dislocation in a patient who presented to our institution within 6 hours of trauma. The dislocations were promptly reduced under propofol anesthesia in the operating room. The patient did not suffer a concurrent fracture. After the procedure, we performed regular X-ray examinations for 2 years to rule out the development of avascular necrosis of the head of the femur. The course of the patient was unremarkable.; Summary

Editorial

Near-death experiences in 19th century Korean tales: Kun Hwang; J Trauma Inj. 2023;36(2):75-77. Published online August 5, 2022; DOI: https://doi.org/10.20408/jti.2022.0020

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PDF: Summary

Original Articles

Types of injuries caused by isolated electric scooter accidents: Kyongwon Yoo, Hyung Il Kim; J Trauma Inj. 2022;35(4):232-239. Published online August 5, 2022; DOI: https://doi.org/10.20408/jti.2022.0010

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Abstract PDF: Purpose
The recent increase in electric scooter (e-scooter) use has been accompanied by an increase in injuries from e-scooter–related accidents. Studies have reported that most such injuries are minor, and physicians may therefore underestimate the severity of such injuries. This study investigated the types and severity of injuries caused by isolated e-scooter accidents (i.e., those that did not involve colliding with other cars or falling from heights).
Methods
This prospective observational study was conducted from May to December 2021 at our academic tertiary medical center. The demographic data of patients injured in isolated e-scooter–related accidents were collected. All injuries were categorized by body part.
Results
Fifty eligible patients visited our emergency department during the study period. Of these, 76% were categorized as nonemergency, and 62% were discharged after initial evaluation and treatment at the emergency department. Another 10% were admitted to the intensive care unit (ICU) and 18% to the ward, with nine patients receiving at least one operation. The average hospital stays were 2.4 days in the ICU and 9 days in the ward. One death occurred due to traumatic brain injury (overall mortality rate, 2%). Multiple fractures of the left third through ninth ribs combined with lung laceration and fractures of T12 and L4 were noted.
Conclusions
Various types and severities of injuries can occur in isolated e-scooter accidents. While most such injuries are minor, some will require ICU admission or surgery, and deaths can occur. Physicians should not underestimate the severity of such injuries.; Summary

Outcomes after rib fractures: more complex than a single number: Kristin P. Colling, Tyler Goettl, Melissa L. Harry; J Trauma Inj. 2022;35(4):268-276. Published online August 5, 2022; DOI: https://doi.org/10.20408/jti.2021.0096

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Abstract PDF: Purpose
Rib fractures are common injuries that can lead to morbidity and mortality.
Methods
Data on all patients with rib fractures admitted to a single trauma center between January 1, 2008 and December 31, 2018 were reviewed.
Results
A total of 1,671 admissions for rib fracture were examined. Patients’ median age was 57 years, the median Injury Severity Score (ISS) was 14, and the median number of fractured ribs was three. The in-hospital mortality rate was 4%. Age, the number of rib fractures, and Charlson Comorbidity Index scores were poor predictors of mortality, while the ISS was a slightly better predictor, with area under the receiver operating characteristic curve values of 0.60, 0.55, 0.58, and 0.74, respectively. Multivariate regression showed that age, ISS, and Charlson Comorbidity Index score, but not the number of rib fractures, were associated with significantly elevated adjusted odds ratios for mortality (1.03, 1.14, and 1.28, respectively).
Conclusions
Age, ISS, and comorbidities were independently associated with the risk of mortality; however, they were not accurate predictors of death. The factors associated with rib fracture mortality are complex and cannot be explained by a single variable. Interventions to improve outcomes must be multifaceted.; Summary

Case Reports

Detection of pharyngeal perforation during fiberoptic endoscopic evaluation of swallowing in a person with cervical spinal cord injury in the intensive care unit: a case report: Min Soo Choi, Sang Hun Han, Yong Beom Shin, Myung Hun Jang; J Trauma Inj. 2022;35(Suppl 1):S40-S45. Published online July 22, 2022; DOI: https://doi.org/10.20408/jti.2022.0016

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Abstract PDF: Endotracheal tube insertion and mechanical ventilation are indicated in spinal cord injury patients; however, dysphagia can occur after extubation. The resultant complications of dysphagia may increase the length of hospital stay and mortality. Therefore, dysphagia should be evaluated after extubation. This case report introduces a rare case of finding pharyngeal perforation during the fiberoptic endoscopic evaluation of swallowing (FEES) in patients with cervical spine injuries in the intensive care unit. A 71-year-old male patient met with a road traffic accident. The patient underwent C3–4 posterior fusion and C3–4 anterior cervical discectomy and fusion. After successful extubation, the patient underwent FEES to assess swallowing function. During FEES, the metallic plate was found to be exposed through mucosal erosion, and swelling was observed at the surgical site at the hypopharynx. The nasogastric tube was removed to prevent secondary damage and infection at the operation site and the patient was received conservative therapy. The FEES endoscope machine is portable so it can be easily applied at the bedside to intensive care unit patients. In addition, FEES allows the identification of anatomical abnormalities of the oropharynx and abnormalities of vocal cord. Thus, it is recommended to do FEES to check anatomical abnormalities as well as dysphagia in patients in the intensive care unit.; Summary

Azygos and right superior intercostal vein injury secondary to blunt trauma: a case report: Nima Yaftian, Benjamin Dunne, Phillip Antippa; J Trauma Inj. 2023;36(1):53-55. Published online July 21, 2022; DOI: https://doi.org/10.20408/jti.2022.0001

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Abstract PDF: Azygos vein injuries are rare consequences of blunt trauma. When there is high drainage output from a right-sided intercostal catheter, an azygos injury must be considered in the differential diagnosis. We report the case of a 38-year-old male patient involved in a fall from a height during a motorcycle accident. Computed tomography demonstrated a large right-sided hemothorax and left-sided pneumothorax. The patient was transferred to the operating theatre and underwent a clamshell thoracotomy. A laceration in the azygos vein at the confluence of the arch of the azygos and the right superior intercostal vein was identified. Bleeding was controlled at the trifurcation. The patient survived and was discharged home on postoperative day 15.; Summary

Extraanatomic bypass grafting in a patient with an infected femoral defect caused by a rollover accident: a case report: Dae Sung Ma, Dong Hun Kim, Jae-Wook Ryu, Sung Wook Chang; J Trauma Inj. 2022;35(Suppl 1):S23-S26. Published online July 21, 2022; DOI: https://doi.org/10.20408/jti.2021.0005

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Abstract PDF: A 59-year-old male patient presented to the emergency department after a tractor rollover accident. His Injury Severity Score was 41 points. He had multiple pelvic bone fractures and a left common femoral artery injury with soft tissue loss. The injured arteries with skin defect were initially managed with endarterectomy and primary repair. However, the sepsis secondary to the infection from a skin defect became uncontrolled. The infected wound developed massive hemorrhage from the repaired arteries. Supportive measures were initiated to achieve hemostasis but unsuccessful. We performed an anastomosis with a prosthetic graft from the common iliac artery to the femoral artery above the knee, avoiding the wound through the lateral side of the anterior superior iliac spine. After revascularization, the patient recovered uneventfully. An extraanatomic graft reconstruction should be considered early when the autologous vein is unsuitable.; Summary

Original Article

Sports injuries: a 5-year review of admissions at a major trauma center in the United Kingdom: Ahmad Hammad Hassan, Aref-Ali Gharooni, Harry Mee, James Geffner, Fahim Anwar; J Trauma Inj. 2023;36(1):39-48. Published online July 14, 2022; DOI: https://doi.org/10.20408/jti.2021.0084

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Abstract PDF: Purpose
Sports offer several health benefits but are not free of injury risk. Activity dynamics vary across sports, impacting the injury profile and thereby influencing healthcare resource utilization and health outcomes. The purpose of this study was to investigate sports-related major trauma cases and compare differences across sports and activity groups.
Methods
A retrospective case notes review of sports-related major traumas over a 5-year period was conducted. Demographic, hospital episode-related, and health outcome-related data were analyzed, and differences were compared across sports and activity groups. The Glasgow Outcome Scale (GOS) at discharge was used as the primary outcome measure and the length of hospital stay as the secondary outcome measure.
Results
In total, 74.6% of cases had good recovery at discharge (GOS, 5), 18.9% had moderate disability (GOS, 4), and 3.7% had severe disability (GOS, 3). The mean length of hospital stay was 11.2 days (range, 1–121 days). The most severely injured body region was the limbs (29.1%) and vertebral/spinal injuries were most common in terms of location (51.8%). A significant difference (P<0.05) existed in GOS across sports groups, with motor sports having the lowest GOS. However, no significant differences (P>0.05) were found in other health-outcome variables or injury patterns across sports or activity groups, although more competitive sports cases (67.08%) required admission than recreational sports cases (32.9%).
Conclusions
Spinal injuries are the most frequent sports injuries, bear the worst health outcomes, and warrant better preventive measures. Head injuries previously dominated the worst outcomes; this change is likely due to better preventive and management modalities. Competitive sports had a higher injury frequency than recreational sports, but no difference in health outcomes or injury patterns.; Summary

Review Article

Writing papers: literary and scientific: Kun Hwang; J Trauma Inj. 2022;35(3):145-150. Published online June 29, 2022; DOI: https://doi.org/10.20408/jti.2022.0006

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Abstract PDF: This paper aims to summarize why I write, how to find a motif, and how to polish and finish a manuscript. For William Carlos Williams, practicing medicine and writing poetry were two parts of a single whole, not each of the other. The two complemented each other. Medicine stimulated Williams to become a poet, while poetry was also the driving force behind his role as a doctor. Alexander Pope, the 18th century English poet, wrote a poem entitled “The Epistle to Dr. Arbuthnot” that was dedicated to a friend who was both a poet and a physician. In this poem, we receive an answer to the questions of ‘‘Why do you write? Why do you publish?’’ Pope writes, “Happy my studies, when by these approv’d! / Happier their author, when by these belov’d! / From these the world will judge of men and books.” When I write, I first reflect on whether I only want to write something for its own sake, like “a dog chasing its own tail,’’ instead of making a more worthwhile contribution. When my colleagues ask me, “Why do you write essays as well as scientific papers?” I usually answer, “Writing is a process of healing for me—I cannot bear myself unless I write.” When the time comes to sit down and put pen to paper, I remind myself of the saying, festina lente (in German, Ohne Hast, aber ohne Rast, corresponding to the English proverb “more haste, less speed”). If I am utterly exhausted when I finish writing, then I know that I have had my vision.; Summary

Case Report

Successful surgical intervention in traumatic carotid artery thrombosis after a motor vehicle accident: a case report: Görkem Yiğit; J Trauma Inj. 2023;36(1):49-52. Published online June 29, 2022; DOI: https://doi.org/10.20408/jti.2021.0095

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Abstract PDF: Blunt carotid artery injury can lead to impaired brain perfusion due to ischemic stroke and thromboembolic events. To reduce the risk of potential neurological complications, it is critical to determine the diagnosis and management protocol as quickly as possible after a detailed clinical examination. This report presents successful surgical treatment of a young male patient who developed a traumatic left common carotid artery thrombosis after a motor vehicle accident.; Summary

Original Article

Can parents prevent tooth loss related to dental avulsion? An assessment of knowledge related to permanent teeth: Gowri Sivaramakrishnan, Deena Abawi, Fatima Mohammad Shoaib, Fatema Bucheery, Ahmed Ali Salman, Majeed Jasim Kadhem, Fatema AlSulaiti, Muneera Alsobaiei, Leena AlSalihi; J Trauma Inj. 2023;36(1):15-21. Published online June 29, 2022; DOI: https://doi.org/10.20408/jti.2021.0094

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Abstract PDF: Purpose
Dental avulsion injuries have a poor prognosis that largely depends on the immediate steps taken to manage the avulsed tooth. A lack of knowledge about the initial management can lead to tooth loss, with further adverse implications for esthetics, phonetics, and overall growth and function. Hence, the present study aimed to assess parents’ knowledge regarding dental avulsion and the variables associated with their knowledge of avulsion injuries.
Methods
A series of closed-ended questions on parents’ knowledge regarding avulsion, such as immediate management, storage media, handling, and urgency of visiting the dentist, was asked. Univariate associations between the outcomes were assessed using the Pearson chi-square test. The chi-square goodness-of-fit test was used to check whether the sample data were representative of the population.
Results
In total, 211 mothers and 149 fathers were included, of whom 46.7% had experienced dental trauma during their own childhood. Sixty-one percent of mothers believed that they knew everything necessary about tooth avulsion and its management. A significant number of participants who thought that they had a good level of knowledge about avulsion chose water, tissue, or paper wrap to transport the tooth, and preferred tap water, alcohol, or antiseptic to clean the avulsed tooth.
Conclusions
Both mothers and fathers had poor knowledge about tooth avulsion, indicating that there is an immediate need for educational programs focusing on this issue. Since a substantial proportion of participants believed incorrect information, it is vital to disseminate accurate information.; Summary

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