Journal of Trauma and Injury

Volume 25(1); March 2012

Original Articles

Clinical Characteristics of Unstable Pelvic Bone Fractures Associated with Intra-abdominal Solid Organ Injury: Sang Won Lee, Sun Hyu Kim, Eun Seog Hong, Ryeok Ahn; J Korean Soc Traumatol. 2012;25(1):1-6.

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Abstract PDF: PURPOSE
This study analyzed the characteristics of unstable pelvic bone fractures associated with intraabdominal solid organ injury.
METHODS
Medical records were retrospectively collected from January 2000 to December 2010 for patients with unstable pelvic bone fractures. Unstable pelvic bone fracture was defined as lateral compression types II and III, antero-posterior compression types II and III, vertical shear and combined type by young classification. Subjects were divided into two groups, with (injured group) and without (non-injured group) intra-abdominal solid organ injury, to evaluate whether the characteristics of the fractured depended on the presence of associated solid organ injury. Data included demographics, mechanism of injury, initial hemodynamic status, laboratory results, revised trauma score (RTS), abbreviated injury scale (AIS), injury severity score (ISS), amount of transfusion, admission to the intensive care unit (ICU), and mortality.
RESULTS
The subjects were 217 patients with a mean age of 44 years and included 134 male patients(61.8%). The injured group included 38 patients(16.9%). Traffic accidents were the most common mechanism of injury, and lateral compression was the most common type of fracture in all groups. The initial blood pressure was lower in the injured group, and the ISS was greater. The arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. The amount of the transfused packed red blood cells within 24 hours was higher in the injured group than the non-injured group. Invasive treatment, including surgery and angiographic embolization, was more common in the injured group, and the stay in the ICU was longer in the injured group.
CONCLUSION
A need exists to decide on a diagnostic and therapeutic plan regarding the possibility of intraabdominal solid organ injury for hemodynamically unstable patients with unstable pelvic bone fractures and multiple associated injuries.; Summary

Analysis of Surgical Treatment and Factor Related to Closed Reduction Failure for Patients with Traumatically Locked Facets of the Subaxial Cervical Spine: Sung Hwa Paeng; J Korean Soc Traumatol. 2012;25(1):7-16.

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Abstract PDF: PURPOSE
Cervical dislocations with locked facets account for more than 50% of all cervical injuries. Thus, investigating a suitable management of cervical locked facets is important. This study examined factors of close reduction failure in traumatically locked facets of the subaxial cervical spine patients to determine suitable surgical management.
METHODS
We retrospectively analyzed of the case histories of 28 patients with unilateral/bilateral cervical locked facets from Nov. 2004 to Dec. 2010. Based on MRI evaluation of disc status at the injury level, we found unilateral dislocations in 9 cases, and bilateral dislocations in 19 cases, The patients were investigated for neurologic recovery, closed reduction rate, factors of the close reduction barrier, fusion rate and period, spinal alignment, and complications.
RESULTS
The closed reduction failed in 23(82%) patients. Disc herniation was an obstacle to closed reduction (p=0.015) and was more frequent in cases involving a unilateral dislocation (p=0.041). The pedicle or facet fracture was another factor, although some patients showed aggravation of neurologic symptoms, most patients had improved by the last follow up. The kyphotic angle were statistically significant (p=0.043). Sixs patient underwent anterior decompression/fusion, and 15 patients underwent circumferential fusion, and 7 patients underwent posterior fusion. All patients were fused at 3 months after surgery. The complications were 1 case of CSF leakage and 1 case of esphageal fistula, 1 case of infection.
CONCLUSION
We recommend closed reduction be performed as soon as possible after injury to maximize the potential for neurological recovery. Patients fot whom closed reduction of the cervical locked facets have a higher incidence of anatomic obstacles to reduction, including facet fractures and disc herniation. Immediate direct open anterior reduction or circumferential fixation/fusion of locked cervical facets is recommended as a treatment of choice for traumatic locked cervical facet patients after closed reduction failure.; Summary

Effect of Therapeutic Hypercapnia on Systemic Inflammatory Responses in Hemorrhagic Shock in Rats: Kyeong Won Kang, You Hwan Jo, Kyuseok Kim, Jae Hyuk Lee, Joong Eui Rhee; J Korean Soc Traumatol. 2012;25(1):17-24.

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Abstract PDF: PURPOSE
This study was performed to investigate whether therapeutic hypercapnia could attenuate systemic inflammatory responses in hemorrhagic shock in rats.
METHODS
Male Sprague-Dawley rats were mechanically ventilated and underwent pressure-controlled (mean arterial pressure: 38+/-1 mmHg) hemorrhagic shock. At 10 minutes after the induction of hemorrhagic shock, the rats were divided into the normocapnia (PaCO2=35-45 mmHg, n=10) and the hypercapnia (PaCO2=60-70 mmHg) groups. The PaCO2 concentration was adjusted by using the concentration of inhaled CO2 gas. After 90 minutes of hemorrhagic shock, rats were resuscitated with shed blood for 10 minutes and were observed for 2 hours. The mean arterial pressure (MAP) and the heart rate were monitored continuously, and the results of arterial blood gas analyses, as well as the plasma concentrations of interleukin (IL)-6, IL-10, and nitrite/nitrate were compared between the normocapnia and the hypercapnia groups.
RESULTS
The MAP and the heart rate were not different between the two groups. The plasma concentration of IL-6 was significantly lower in the hypercapnia group than in the normocapnia group (p<0.05). The IL-10 concentration was not different and the IL-6 to IL-10 ratio was significantly lower in the hypercapnia group compared to the normocapnia group. The plasma nitrite/nitrate concentration of the hypercapnia group was lower than that of the normocapnia group.
CONCLUSION
Therapeutic hypercapnia attenuates systemic inflammatory responses in hemorrhagic shock.; Summary

Case Reports

A Hip 14 Years after a Non-surgiclly-treated Pipkin Type-II Fracture of the Femoral Head: A Case Report: Young Kyun Lee, Yong Chan Ha, Kyung Hoi Koo; J Korean Soc Traumatol. 2012;25(1):25-27.

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Abstract PDF: A 30-year-old, male truck driver had a traffic accident and visited a hospital due to left hip pain. The patient's femoral head was fractured, and he was treated conservatively. For 14 years afterwards, he walked without a limp, had no pain, and drove his truck. He was involved in another traffic accident and experienced a comminuted fracture of the left distal femur 14 years after the initial injury. Although he was symptom-free, while being treated by open reduction and internal fixation for the distal femur fracture, he was concerned about the status of his left femoral head. Pelvis radiographs and reconstructed CT images were done, and they showed a spur change around the femoral head which had a dense sclerotic band within and revealed a slight depression of subchondral bone of the medial portion of the femoral head. The diagnosis was a Pipkin type-II fracture of the femoral head.; Summary

Penetrating Orbitocranial Injury of a Pencil in a Pediatric Patient: Sun Chul Hwang; J Korean Soc Traumatol. 2012;25(1):28-31.

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Abstract PDF: Pencils are common instruments for children to use and play with. This report describes an unusual penetrating orbitocranial injury in a 5-year-old girl who was struck in her facewith a pencil. She was holding it at a desk, and her friend pushed her back. The pencil penetrated the left lower eyelid and went deep into the right frontal lobe through the base of the skull. It was removed at the emergency room, after which brain CT was performed to detect the development of an intracranial hematoma. No complications occurred after conservative management with antibiotics and an antiepileptic drug. Pencils can be hazardous to children, and a penetrating head injury with a pencil may be managed without cranial surgery.; Summary

Traumatic Internal Maxillary Artery Pseudoaneurysm Caused by Fracture of the Mandible Ramus: A Case Report: Chang Dok Han, Young Hyo Kim, Kyu Sung Kim, Hoseok Choi; J Korean Soc Traumatol. 2012;25(1):32-35.

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Abstract PDF: Traumatic pseudoaneurysms in the head and neck region are very rare. Particularyly, pseudoaneurysms of the internal maxillary artery are known to be very rare. The authors report a 20-year old male who was diagnosed as having a pseudoaneurysm of the internal maxillary artery. The cause was assumed to be a mandible ramus fracture. When he visited our emergency room, we did not consider a pseudoaneurysm because of his other life-threatening conditions. Fortunately, he re-visited our hosipital before the aneurysm ruptured. He was diagnosed with angiography and was treated by using embolization with glue. The rupture of the pseudoaneurysm could have caused a life-threatening hemorrhage.; Summary

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