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Volume 15(1); June 2002
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Original Articles
Treatment of Donor-site Wounds Using Foam Dressing Material
Do Hern Kim, M.D., Jong Hyun Kim, M.D., Younb Nam-Koong, M.D., Dong Kun Kim, M.D., and Yoon Kyu Park, M.D.
J Korean Soc Traumatol. 2002;15(1):1-7.
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AbstractAbstract PDF
Background
s : Donor-site wounds vary in thickness and have a nonadherent layer that provides nontraumatic removal. Foams create a moist environment and provide thermal insulation to the wound. General characteristics of dressings include nonadherents and may repel contaminants, be eased to apply and remove, absorb minimal to heavy amounts of exudate, and may be used under compression. Foam dressings may be used as primary and secondary dressings for wounds with minimal, moderate, or heavy drainage. The purpose of this clinical study was to evaluate the efficacy as a donor-site dressing for thermally injured patients. Methods : We prospectively have analyzed 80 burned patients requiring split-skin grafts. All grafts were removed using a Zimmer dermatome set. We covered one side of each donor site with a hydrophilic polyurethane foam dressing are half the medifoam® (treatment group) and the other half the vaseline gauze (control group). After hemostasis had been obtained, each donor site was covered with a polyurethane foam dressing; vaseline gauze. At 2 days postoperatively, a dressing were removed (first opening) and then, the donor sites was observed daily until epithelization was complete or until a complication developed that required discontinuance of the study. We examined donor site about epithelization, discharge, infection, scar formation, color, and pain. Results: Eighty patients had their donor sites heal without severe complication in a mean time (for complete healing) of 10.1 days for polyurethane foam areas, and 13.0 days for fine mesh vaseline gauze dressings. In seven cases, superficial wound infection occurred in the control no hematoma, no infection, and little pain. the Treatment group was healed with even homogeneous,group. the treatment group had cleaner wound surfaces because of absorption of discharge, Conclusions : Polyurethane foam dressing improves epidermal wound healing by providing a moist environment for enhanced epidermal cell migration and by shortening the donor site healing
Summary
Small Bowel Perfo ration After Blunt Abdominal Trauma : What are the Prognostic Fac tors ? A Retrospective Study from 1985 to 2000
Seung Chul Lee, M.D., Sung Jun Park, M.D., Myung Chun Kim, M.D., and Young Gwan Ko, M.D.
J Korean Soc Traumatol. 2002;15(1):8-13.
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Background
: Blunt small bowel injury (SBI) is infrequent. Although it has been reported to be the third most common injury in blunt abdominal trauma, it occurs in less than 1% of blunt trauma victims. The purposes of this study were to evaluate the relationship between prognostic factors and outcomes of small bowel injury after blunt abdominal trauma. We also attempted to design an algorithm of evaluation to facilitate the detection of hollow organ injury, while at the same time reducing the risk of nontherapeutic laparotomy. Method : A retrospective chart review of all blunt trauma patients with small bowel injury (SBI) admitted to a level 3 trauma center between January 1985 and December 1996 was undertaken. Each record was reviewed for laboratory finding and diagnostic method. Result : A total of 71 patients met the inclusion criteria: 85.9% were male, the mean age was 40.9 years, the mean GCS score was 13.9, the mean RTS score was 21.5, and the mean Injury Severity Score was 16.5. Twenty-six patients had multiple injuries, and forty-five patients had isolated small bowel injuries. There were 6 deaths (8.4%), and a total of 22 patients suffered complications. Conclusion : In the case of initial management for blunt abdominal injured patients who also have multiple trauma, the time interval between injury and surgery, the trauma score (GCS, RTS), and ISS were important prognostic factors. If the patients’ initial GCS score levels were below 10, it was a good idea to use as invasive diagnostic modality (DPL) actively to reduce preventable mortality and morbidity in the emergency department.
Summary
Nonoperative Management of Blunt Hepatic Trauma
Sung Min Choi, M.D., Man Kyu Chae, M.D. Tae Yun Kim, M.D., Sung Yong Kim, M.D., Moo Jun Baek, M.D., Moon Soo Lee, M.D., and Chang Ho Kim, M.D.
J Korean Soc Traumatol. 2002;15(1):14-21.
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Background
: Nonoperative treatment of liver injuries resulting from blunt trauma has gained acceptance over the past decades. The utilization of computerd tomography in the evaluation of blunt abdominal trauma provides the opportunity for nonoperative and observational management in selected patients with blunt hepatic trauma. The aim of this study was to evaluate the safety of nonoperative management of blunt hepatic trauma in hemodynamically stable patients. Methods : Ninety patients(90) with traumatic liver injuries who were admitted to the department of surgery, Soonchunhyang University Chunan Hospital, from July 1989 to June 2001, were treated by nonoperative treatments. The records of these patients were reviewed and compared with those of the operated patients (217 cases). Result : The peak incidence was the 3rd decade, and the male-to-female ratio was 2:1. The most frequent injury mechanism was traffic accident. The abdominal CT was the diagnostic modality used most frequently, and it was performed in all cases of nonoperative treatment. Chest injury was the most common associated one. The degree of injury was classified by using the AAST (American Association for the Surgical Trauma). Grade I was the most common type (39 cases, 43.3%). Between the nonoperative group and the operative group, there were significant differences in systolic blood pressure, hemoglobin level, sGPT level, serum Alkaline phosphatase level, the amount of transfusion, and the injury severity score (P<0.05). Postoperative complications were noted in 10 of the 90 (12.2%) nonoperative patients and in 67 patients (30.8%). the postoperative mortality rate was 3.3% (3cases), and all were due to head injury. Conclusion: Nonoperative management of blunt hepatic injuries based on abdominal CT findings is a useful treatment modality in a selected group of hemodynamically stable patients. The key to successful nonoperative management lies in strict adherence to the selection protocol and aggressive monitoring with intensive care.
Summary
Diagnostic Tools of Fat Embolism Syndrome in Trauma
Ryuk Ahn, M.D., Kyoung-Soo Lim, M.D., Won Kim, M.D., Won Young Kim, M.D., and Youn-Baik Choi, M.D.*
J Korean Soc Traumatol. 2002;15(1):22-27.
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Purpose
: The purpose of this research is to estimate the diagnostic tool of fat embolism syndrome (FES) in trauma patients with long bone fracture and to compare the accuracy as a diagnostic tool. Methods : We retrospectively reviewed the medical records of 17 patients in whom FES was diagnosed from August 1, 1989, to March 31, 2002. The clinical symptoms and signs of FES were analyzed, and the result of radiologic studies, such as lung perfusion scans, pulmonary venography, thromboembolic CT scans, brain CT scans, brain diffusion MRI, were evaluated. Results : In evaluating the fracture patterns, 11 patients (65%) had multiple long-bone fractures and 6 patients (35%) had a single long-bone fracture. The diagnosis of FES was made by using Gurd’s clinical criteria including hypoxia: 17 patients (100%); mental status changes, 13 patients (76%); thrombocytopenia, 12 patients (71%); petechiae, 4 patients (24%); fever, 8 patients (47%); unexplained anemia, 14 patients (82%); and tachycardia, 10 patients (59%). The diagnostic accuracy of radiologic tools were as follows: only one case showed pulmonary embolism in a lung perfusion scan, but other studies, such as pulmonary venography and a thromboembolism CT scans were negative. The brain CT scan did not show abnormal findings, but one case of brain diffusion MRI showed an embolic brain lesion. Conclusion : We conclude that FES remains a diagnosis of exclusion based on clinical criteria. Radiologic tools do not effectively show embolic lesions of the lung or brain.
Summary
Efficacy of Computed To mography in Facial Trauma
Woo Jeong Kim, M.D., Jung Ho Shin, M.D., Sung Koo Jung, M.D., Joong Eui Rhee, M.D., Gil Joon Suh, M.D., Yeo Kyu Youn, M.D.*, Chang Hyun Lee, M.D.**, Hyoung Gon Song, M.D.***
J Korean Soc Traumatol. 2002;15(1):28-32.
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Background
s : Facial trauma is presented as various situations. As a diagnostic modality, a conventional X-ray study has been to be inaccurate in finding the possible fracture of the facial bone. Thus, it is important to select more accurate radiologic modalities for early detection and management of fractures. The purpose of this study was to compare computed tomography with conventional X-ray studies and to determine the usefulness of computed tomography in patients with facial trauma. M e t h o d s : The medical records and radiologic findings of conventional X-ray studies and computed tomography in 45 patients with facial trauma, who visited our emergency room from July 1, 2001, to December 31, 2001, were reviwed retrospectively. The Sensitivity, specificity, positive and negative predictive values of conventional X-ray study were calculated based on formal readings of computed tomography. The differences between conventional X-ray studies and computed tomography were also calculated by using the Fisher’s exact test. Results : The male-to-female ratio and the mean age were 3.5 and 38.3 yrs, respectively. On comparison with computed tomography, the sensitivity and the specificity of conventional X-ray studies were 47.6% and 100%, respectively. The positive and negative predictive values were 100% and 68.6%, respectively. Conclusions : We suggest that computed tomography may be a more useful radiologic modality than conventional an X-ray study in finding possible fractures of facial bones.
Summary
Trigger Point Injection for the Treatment of Cervical Strain In the Emergency Department
Gi Woon Kim, M.D., Sang Cheon Choi, M.D., Hyun Jong Song, Ph.D., Young Shin Bae, M.D., Joon Pil Cho, M.D. and Yoon Seok Jung, M.D.
J Korean Soc Traumatol. 2002;15(1):33-38.
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AbstractAbstract PDF
Background
: The common precipitating events of whiplash injury are motor vehicle crashes, falls, or sport injuries. When cervical strain with myofascial symptoms occur, systemic nonsteroidal agents are not very effective. Methods: One group pretest posttest design. We had 35 patients (male: 24; female: 11) enrolled in the study from April 1998 to August 1999. Prior to lidocaine injection therapy, a pain score ‘10’ was given to all patients, regardless of intensity of their complaints. We measured the pain score after the injection at an intervals of 5 minutes, 10 minutes, and before discharge. We measured not only the pain score but also the range of motion (rotation, flexion, and extension) after trigger point injection therapy. Results: Thirty (30) out of 35 patients reported improvement within 10 minutes, and the change in the pain score was from 10 to 4.7 (p<0.05). Also, 19 out of 15 patients showed a remarkable improvement. Conclusion: Trigger point (TrP) injection therapy as a pain control in emergency room is very effective. Further study is required.
Summary
Child Car Seat Use and Related Factors
Joon Pil Cho, M.D., Hyun Jong Song, M.P.H., Kyung Won Paek, M.P.H.
J Korean Soc Traumatol. 2002;15(1):39-48.
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AbstractAbstract PDF
Background
: Injuries caused by motor vehicle crashes are the leading causes of death in children. An effective countermeasures in prevening the children from unnecessary premature death is child safety seat. The objectives of this study was to determine the attitude and knowledge of parents about child safety seat as well as to identify factors affecting child safety seat use. Material and Method : Data came from telephone interview surveys using a questionnaire of 1,784 car owners who have children aged 2 or 3years old. Awareness, ownership and child safety seat usage were investigated. Socioeconomic status, perceptions of susceptibility, severity, and benefits were analyzed as independent variables according to Health Belief Model and frequency of child safety seat use as the dependent variable. Result : Of the subjects, 1,461 (81.9%) knew about the child safety seat. Among these, 610 (41.8%) had a child safety seat and 302 (20.7%) used it at any circumstances. Factors affecting ‘the use of a child safety seat under any circumstances’ were high level of education (OR=1.64), perceptions of severity (OR=1.01), and perception of benefit (OR=1.98); therefore car owners who received a university education perceived a high level of severity and benefit always use the child safety seat. Conclusion : Based on these results, various interventions to motivate child safety seat usage are needed. For the child safety seat pervading programs to be developed and implemented, it is essential to consider the factors affecting the use of child safety seat such as the perceptions of severity and benefits.
Summary
Emergency Department Evaluation of Neuropsychiatric Complication foll owing Traumatic Injuries
Chang Hyun Kim, M.D., Hyuk Jun Yang, M.D., Gun Lee, M.D., Yong Su Lim, M.D., and Sung Youl Hyun, M.D.
J Korean Soc Traumatol. 2002;15(1):49-57.
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AbstractAbstract PDF
Background
: Recent studies have suggested that patients with traumatic injuries and neuropsychiatric complications following a traumatic accident can be admitted from the emergency department. Thus, this study was designed to assess the natural course of post-traumatic symptoms formation, as well as the diagnosis and treatments. Methods : We reviewed the cases of patients (n=3906) with traumatic injuries who had been admitted in to Ghil Hospital from Jan. 1, 2000, to June 31, 2001. Among these patients, we only elaborated the 29 patients who had neuropsychiatric complication, but who had never had a history of psychopathy. Result : Twenty-nine patients were studied with a mean age of 42, and the ratio of male and females was 11 to 18. The most common causes of injuries were traffic accidents (72%), assaults (14%) and falls (14%). Patient had clinical symptoms of headaches (64%), vomiting and nausea (11%), chest pain (8%), extremity pain (6%), lower back pain (8%), and abdominal pain (3%). Exposure to traumatic events could often explain the pressure of nonspecific symptoms, such as difficulty concentrating (23%), restricted range of emotions or a feeling of numbness (23%). anxiety (27%), and nightmares and difficulty falling or staying asleep (27%). Twenty-nine patients had psychiatric complication, such as post-traumatic stress disorder (29%), depression (23%), post-concussion syndome (16%),acute stress disorder (6%), insomnia (6%),organic mental disorder (6%), and panic disorder (4%). antianxiety drug (41%), antidepressant drugs (30%), antidepressant and antipsychotic drugsAfter consultation with the neuropsychatric department, treatments were antidepressants and (7%), and antianxiety and antipsychotic drug (4%), antipsychotic drugs (7%) observation (7%), and supportive counseling (4%). Conclusion : This study showed that patients exposed to traumatic injuries, neguined a variety of psychiatric complications and required psychiatric treatments. Thus, we suggest that psychiatric complications are a concern should be a concern after traumatic injures.
Summary
Clinical Analysis of Anterior Reconstruction with Kaneda SR in Treatment of Thoracolumbar Burst Fracture Through the Extrapleural Retroperitoneal Approach
Byung Ook Jung, M.D., Jong In Lee, M.D., Sang Kyu Kim, M.D., Yong Jun Jo, M.D. Seung Koan Hong, M.D., Choon Keun Park, M.D.*, Jang Hoi Hwang, M.D., Myung Soo Ahn, M.D.
J Korean Soc Traumatol. 2002;15(1):58-65.
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AbstractAbstract PDF
Study Design : At, retrospective clinical study was performed for twenty-nine (29) with thoracolumbar burst fractures who underwent anterior decompression and reconstruction using Kaneda SR through the extrapleural retroperitoneal ap-proach. Objectives : This study was performed to determine the effectiveness and the safety of anterior decompression and reconstruction using Kaneda SR in patients with thoracolumbar burst fractures. Background of Data : The treatment of thoracolumbar burst fractures using Kaneda SR have been reported to have various results and complications. Additional data are needed to support the outcome. This report includes the result of our initial experience using Kaneda SR in the treatment of the thoracolumbar burst fractures. Materials and Methods : Twenty-nine consecutive patients with thoracolumbar burst fractures extrapleural retroperitoneal approach were included in this study. The surgery was done withwho underwent anterior decompression and reconstruction using Kaneda SR through the single-stage anterior decompression, mesh cage with autologous bone insertion, and Kaneda SR spinal instrumentation through the extrapleural retroperitoneal approach. The average follow-up period was 9 months (range: 4 months to 27 months). Results : The mean age of the patients was 31.6 years old. The fractures were in the thoracolumbar junction (between T11 and L2) in 23 out of 29 fracture levels. Twenty-four cases were associated with neurologic deficit from cord and/or cauda equina injury. In the majority of the patients with neurologic deficit (20 out of 24 patients), the granding an the Franhel scale grade was improved by least are grade, the Average canal compromise was 57.0% preoperatively, and improved to 2.63% postoperatively. the average preoperative kyphotic angle was 19.55 degree, and it was improved to 7.0 degree postoperatively. This correction was lost approximately 2.44 degree in the follow up period. There were no screw fractures or pseudoarthrosis. Complications included a deep wound infection requiring wound revision, a superficial wound infection, and a significant amount of hemothorax requiring postoperative transfusion. Conclusion : The authors suggest that anterior decompression and reconstruction using Kaneda SR through the extrapleural retroperitoneal approach is an effective and safe method in the treatment of thoracolumbar burst fractures. A long-term follow up study is necessary.
Summary
Case Report
Traumatic Sella Turcica Fracture Associated with Abducence Nerve Palsy - A Case report -
Tae Joon Ahn, M.D., Chong Oon Park, M.D., Young Soo Ha, M.D., and Dong Keun Hyun, M.D.
J Korean Soc Traumatol. 2002;15(1):66-68.
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AbstractAbstract PDF
Fractures involving the sella turcica are rare complication of head trauma. Recognition of fractures in this area is very important because serious immediate or delayed neurological, endocrinological and vascular complications may occur, such as cranial nerve palsy, hypopituitarism, and vascular abnormalities.The authors report a case of sella turcica fracture associated with right abducens nerve palsy. The clinical and radiological features are discussed with a review of the literatures.
Summary

J Trauma Inj : Journal of Trauma and Injury