Journal of Trauma and Injury

Volume 26(3); September 2013

Review Article

Current Concept and Future of the Management of Spinal Cord Injury: A Systematic Review: Il Choi, Jin Gyeong Ha, Sang Ryong Jeon; J Trauma Inj. 2013;26(3):63-73.

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Abstract PDF: Spinal cord injury (SCI) is a serious condition associated with social and familial burden, as well as significant neurologic deficit. Despite the many advances in the treatment of spinal cord injury, a fundamental treatment for neurologic functional recovery has not yet been developed. In this article, we review two directions of development for spinal cord injury treatment: neuroprotective pharmacological agents and axon-regenerating cell therapy. We expect developments in these two to lead to improve functional recovery in patients with spinal cord injuries and to reduce burdens on society, as well as the patients' families.; Summary

Original Articles

Incidence of Venous Thromboembolism in Pelvic and Acetabular Fractures in the Korean Population: Sang Ki Lee, Jae Won Lee, Jung Joo Hwang; J Trauma Inj. 2013;26(3):74-80.

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Abstract PDF: PURPOSE
There are no detailed reports on the incidence of venous thromboembolism (VTE) in pelvic and acetabular fractures in the Asian population. The purpose of this study was to investigate the incidence of VTE in pelvic and acetabular fractures in the Korean population.
METHODS
The cases of 67 Korean patients with pelvic and acetabular fractures treated at our hospital from January 2009 to February 2012 were analyzed retrospectively. Until May 2010, VTE screening was performed by contrast-enhanced computed tomography (CT) or ultrasonography (US) when the D-dimer value did not decline predictably, still exceeded 20 microg/ml at 5 days after trauma and surgery, or increased to greater than 20 microg/ml after a period of decline. After May 2010, contrast-enhanced CT and US were performed routinely irrespective of the D-dimer value. Physical prophylaxis was performed on all patients. The effects of the presence of a pelvic and/or acetabular fracture, and the effects of fracture type, accompanying injuries, and screening strategies on the incidences of VTE were investigated.
RESULTS
Overall, 26 patients(38.8%) were diagnosed with VTE and PTE in 14(20.9%). All were asymptomatic. Significantly higher incidences of VTE and PTE were observed in trauma patients with pelvic and acetabular fractures than in trauma patients without pelvic and acetabula fractures treated during the same period. No significant differences were observed in the incidences of VTE and PTE between patients with pelvic fractures, and patients with acetabular fractures or between patients with and without accompanying injuries. Compared with the previous screening strategy, the detection rates for VTE and PTE were higher for the newer screening strategy; however, the difference did not reach statistical significance.
CONCLUSION
In the Korean population, we should be vigilant for a high incidence of VTE, especially PTE, in patients with pelvic and acetabular fractures.; Summary

Serologic Markers of Excessive Callus formation in Traumatic Brain Injury Patient: Hee Gon Park, Yeon Jun Kim; J Trauma Inj. 2013;26(3):81-88.

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Abstract PDF: PURPOSE
Among patients with multiple traumatic fractures, a tendency to form more callus exists in groups with multiple fractures combined with traumatic brain injury. This retrospective study evaluated the hematologic factors that might be useful to predict callus formation by comparing serologic tests and clinical and radiologic results in two groups.
METHODS
From January 2000 to December 2010, patients with femur shaft fractures were divided in two groups: one without traumatic brain injury (control group: 32 cases), and the other with traumatic brain injury (study group: 44 cases). We evaluated routine serologic exams and the amount of callus formation during the follow-up period.
RESULTS
Only the alkaline phosphatase level was statistically different between the two groups, not the White blood cell count, C-reactive protein, total calcium, and lactate dehydrogenase level. The amount of callus formation on the antero-posterior radiograph at the last follow up period was 74.9% in the study group and 42.1% in the control group. Then lateral radiograph showed 73.2% callus formation rate in the study group and 31.8% in the control group.
CONCLUSION
In routine serologic exams, the two groups had no significant differences, except for the alkaline phosphatase level. The group with traumatic brain injury had much more callus formation, but there was no reliable factor to predict callus formation on the routine serologic exam.; Summary

Evaluation of the Triage by Emergency Medical Technicians by Using Trauma Score for Occupant Injuries Caused by Motor Vehicle Collisions: Sang Chul Kim, Byung Woo Kim, Yang Ju Tak, Sang Hee Lee; J Trauma Inj. 2013;26(3):89-98.

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Abstract PDF: PURPOSE
The assessment of trauma patients in the prehospital setting is difficult, but appropriate field triage is critical to the prognosis of trauma patients. We sought to evaluate the triage given by the emergency medical technicians (EMTs) using the trauma score to patients injured in motor vehicle collisions (MVCs).
METHODS
From June 2012 to July 2012, questionnaires were distributed to EMTs, who had transported injured patients to the study hospital. Scene records, photos of the damaged vehicle, and ambulance run sheets were used to provide physiologic, physical, and mechanistic information about the MVC. To evaluate the appropriateness of the injury assessment by EMTs, we compared their impressions with the hospital's final diagnosis within a 3 level triage system comprising both the maximum abbreviated injury scale (MAIS) and the injury severity score (ISS). Kappa (k) was calculated to evaluate the agreement between the triage by EMTs and the triage based on hospital's final diagnosis.
RESULTS
A total of 91 patients were analyzed by 31 EMTs. The percentage of males was 57.1%, the mean age was 44.5, and the mean MAIS and ISS were 2.7 and 16.6 respectively. While EMTs correctly diagnosed patient injuries to the extremities in 35.7%, and to the neck in 32.1%, pelvic injuries were missed in 80.0%. The agreement between the triage by the EMTs and the triage based on the hospital's final diagnosis was 62.6%(k=0.366) by the MAIS and 50.5%(k=0.234) by the ISS. The kappa value was higher in EMT-I than in EMT-II.
CONCLUSION
In MVC, the assessment of injured patients by EMT-I was more appropriate, and the 3-level triage method based on the MAIS could contribute to a more accurate triage. Prospective studies to search for appropriate methods of field triage are required for programming practical education for EMTs.; Summary

Experience with Operating a Trauma Team at a Local Private University Hospital: Yong Hwan Kim, Young Mo Yang, Jang Young Lee, Won Suk Lee, Won Young Sung, Koung Nam Bark; J Trauma Inj. 2013;26(3):99-103.

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Abstract PDF: PURPOSE
This hospital has operated a trauma system of the inclusive trauma system under the sponsorship of this hospital and with financial support from the government from 2011, and it has been designated as a specialized trauma center (candidate) since November 2008. Therefore, this emergency medical center evaluated the influence of the inclusive trauma system on the course of healing and on the results for trauma patients within the region.
METHODS
The medical records of all patients who were registered as trauma patients from among those who visited the emergency medical center of this hospital from April 2009 to May 2012 were retrospectively reviewed. The monthly and the annual averages of important indices, such as the time in the emergency room and preventable mortalities, were calculated, and patterns of change were sought. The preventable mortality rate was calculated by using the Trauma Injury Severity Score (TRISS) for each patient.
RESULTS
The total number of patients registered from April 2009 to May 2012 was 601, and male patients accounted for a larger proportion(432 males(71.88%) vs. 169 females(28.12%)). Their average age was 46.2 years, the average Revised Trauma Score (RTS) was 5.74 points, and the average Injury Severity Score (ISS) was 26.99 points. The preventable mortality rate during the entire period, which was calculated using the TRISS, appeared lower than the preventable mortality rates reported in past studies in the Republic of Korea.
CONCLUSION
These results for the operation of a new trauma system are limited in that they are only for a local private university hospital. However, results show greater changes and developments in and out of the hospital due to multilateral endeavors by the trauma team and the hospital. These endeavors include increased communications among the departments and development of a complementary patient registration system.; Summary

Availability of the Optic Nerve Sheath Diameter Measured by Using Ultrasonography as a Secondary Survey for Patient with Head Injuries in the Emergency Department: Dong Wook Lee, Jung Won Lee, Sae Hoon Park, Ihl Sung Park, Hyun Jung Lee, Byeong Dae Yoo, Hyung Jun Moon; J Trauma Inj. 2013;26(3):104-110.

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Abstract PDF: PURPOSE
Bedside ultrasonography is available in most emergency departments, and detecting the intracranial pressure is elevated is critical. Our objective is to evaluate the availability of bedside optic nerve ultrasound (ONUS) as a secondary survey for patients with head injuries in the emergency department (ED).
METHODS
From September, 2012, to March, 2013, we performed a prospective study of patients presenting to the ED after an accident. Patients with head injuries but without obvious ocular trauma or ocular disease were included. The ONUS was performed using a 3 to 12 MHz linear probe on closed eyelids after a primary survey. We analyzed the correlation between the brain computed tomography (CT) findings that suggested elevated intracranial pressure (ICP) and the Optic nerve sheath diameter (ONSD) measured by using ONUS.
RESULTS
A total of 81 patients were enrolled. Forty-seven had CT results consistent with elevated ICP, and their mean ONSD was 5.98+/-0.59 mm; the mean ONSD of patients who showed no signs of elevated ICP on CT was 4.63+/-0.21 mm. The sensitivity and the specificity for the ONSD, compared with elevated ICP, were 98.87% and 100%, respectively, when the cut-off value was set to 4.96 mm. The area under curve (AUC) was 0.997 in the receiver operating characteristic curve (ROC curve).
CONCLUSION
An evaluation using ONUS is a simple noninvasive procedure and is a potentially useful tool as a secondary survey to identify an elevated ICP.; Summary

Treatment of Combat-related Gunshot and Explosive Injuries to the Extremities: Jung Eun Lee, Young Ho Lee, Goo Hyun Baek, Kyung Hag Lee, Young Jae Cho, Yeong Cheol Kim, Gil Joon Suh; J Trauma Inj. 2013;26(3):111-124.

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Abstract PDF: PURPOSE
We should prepare proper medical service for disaster control as South Korea is not free from terrorism and war, as we experienced through the two naval battles of the Yeonpyeong, one in 1999 and the other in 2002, the sinking of Cheonan in 2010, and the attack against the border island of Yeonpyeong in 2010. Moreover, North Korea's increasingly bellicose rhetoric and mounting military threats against the world demand instant action to address the issue. The aim of this article is to describe our experience with three patients with combat-related gunshot and explosive injuries to their extremities and to establish useful methods for the management of patients with combat-related injuries.
METHODS
Three personnel who had been injured by gunshot or explosion during either the second naval battle of the Yeonpyeong in 2002 or the attack against the border island of Yeonpyeong in 2010 were included in our retrospective analysis. There were one case of gunshot injury and two cases of explosive injuries to the extremities, and the injured regions were the left hand, the right foot, and the right humerus. In one case, the patient had accompanying abdominal injuries, and his vital signs were unstable. He recovered after early initial management and appropriate emergency surgery.
RESULTS
All patients underwent emergent surgical debridement and temporary fixation surgery in the same military hospital immediately after their evacuations from the combat area. After that, continuous administration of antibiotics and wound care were performed, and definite reconstructions were carried out in a delayed manner. In the two cases in which flap operations for soft tissue coverage were required, one operation was performed 5 weeks after the injury, and the other operation was performed 7 weeks after the injury. Definite procedures for osteosynthesis were performed at 3 months in all cases. Complete union and adequate functional recovery were achieved in all cases.
CONCLUSION
The patient should be stabilized and any life-threatening injuries must first be evaluated and treated with damage control surgery. Staged treatment and strict adherence to traditional principles for open fractures are recommended for combat-related gunshot and explosive injuries to the extremities.; Summary

Characteristics of Patients with Occult Hip Fracture after Hip Trauma: Wookhyun Yu, Hyejin Kim, Sukjin Cho, Sungchan Oh, Taekyung Kang, Seungwoon Choi, Seokyong Ryu; J Trauma Inj. 2013;26(3):125-130.

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Abstract PDF: PURPOSE
This study was undertaken in order to identify the characteristics of patients diagnosed with occult an hip fracture after hip trauma.
METHODS
We retrospectively reviewed the medical records and radiology reports of all patients who underwent hip skeletal computed tomography (CT) for suspected hip fractures but had normal initial X-rays after hip trauma between August 2006 and January 2012. The variables evaluated included age, gender, body mass index (BMI), accident mechanism, previous fracture, independence, late presentation, ability to bear weight, pain on passive rotation, tenderness of the groin area, diagnosis and treatment. Patients were divided into two groups, with hip fracture (occult hip fracture group) and without hip fracture (no fracture group) to evaluate the characteristics associated with an occult hip fracture.
RESULTS
The patients, a total of 139, had a mean age of 58.3 years and included 72 male patients(51.8%). The occult hip fracture group included 43 patients(30.9%). Of those 43, 21 patients(48.8%) had intertrochanteric or trochanteric fractures, 8 patients(18.6%) had femur neck fractures and 14 patients(32.6%) had acetabular fractures. Of the 43, 15 patients(34.9%) needed operative treatment. Age was higher in the occult hip fracture group than it was in the no fracture group(64.4+/-19.1 years vs. 55.5+/-23.6 years, p=0.021). A previous fracture was associated with the presence of a new fracture (p=0.014; OR=3.971, 95% CI=1.314-11.997).
CONCLUSION
Further evaluation of patients who are older or have history of fractures is prudent, even though the initial X-rays are normal.; Summary

Facial Nerve Decompression for Facial Nerve Palsy with Temporal Bone Fracture: Analysis of 25 Cases: Han Ga Wi Nam, Hyung Sik Hwang, Seung Myung Moon, Il Young Shin, Seung Hun Sheen, Je Hoon Jeong; J Trauma Inj. 2013;26(3):131-138.

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Abstract PDF: PURPOSE
The aim of this study is to present a retrospective review of patients who had a sudden onset of facial palsy after trauma and who underwent facial nerve decompression.
METHODS
The cases of 25 patients who had traumatic facial palsy were reviewed. Facial nerve function was graded according to the House-Brackmann grading scale. According to facial nerve decompression, patients were categorized into the surgical (decompression) group, with 7 patients in the early decompression subgroup and 2 patients in the late decompression subgroup, and the conservative group(16 patients).
RESULTS
The facial nerve decompression group included 8 males and 1 female, aged 2 to 86 years old, with a mean age of 40.8. In early facial nerve decompression subgroup, facial palsy was H-B grade I to III in 6 cases (66.7%); H-B grade IV was observed in 1 case(11.1%). In late facial nerve decompression subgroup, 1 patient (11.1%) had no improvement, and the other patient(11.1%) improved to H-B grade III from H-B grade V. A comparison of patients who underwent surgery within 2 weeks to those who underwent surgery 2 weeks later did not show any significant difference in improvement of H-B grades (p>0.05). The conservative management group included 15 males and 1 female, aged 6 to 66 years old, with a mean age of 36. At the last follow up, 15 patients showed H-B grades of I to III(93.7%), and only 1 patient had an H-B grade of IV(6.3%).
CONCLUSION
Generally, we assume that early facial nerve decompression can lead to some recovery from traumatic facial palsy, but a prospective controlled study should and will be prepared to compare of conservative treatment to late decompression.; Summary

The Effect of First-aid Training for Taxi Drivers on Their Willingness to Perform Emergency Care: Hwa Yong Seong, Deuk Hyun Park, Yoo Sang Yoon, Kyung Hye Park, Yang Weon Kim; J Trauma Inj. 2013;26(3):139-150.

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Abstract PDF: PURPOSE
After a traffic accident, first-aid performed within the first few minutes is important for the injured in terms of survival, future health, and quality of life. Taxi drivers have more possibility of witnessing traffic accidents because they spend much time on the road. If taxi drivers are well trained and can perform first-aid in a correct manner, they will play an important role in pre-hospital emergency medical services. We investigated the effect of first-aid training on taxi drivers' willingness to perform emergency care.
METHODS
We provided first-aid training for 600 deluxe taxi drivers in Busan in 2012. The subjects were given a questionnaire to answer at the beginning and at the end of first-aid training.
RESULTS
427 out of 600 deluxe taxi drivers answer our questionnaire completely. 93 out of 427 deluxe taxi drivers answered that they had first-aid training within past 3 years(21.8%). 323 taxi drivers have witnessed a traffic accident(76%). 45 out of 323 deluxe taxi drivers who witnessed a traffic accident answered that they provided first-aid to victims(14.0%). After first-aid training, taxi drivers' willingness to perform emergency care was increased compared to that before training. The failed group of taxi drivers that had same or decreased willingness after first-aid training had a low level of education than the successful group that had increased willingness after first-aid training.
CONCLUSION
First-aid training increased taxi drivers' willingness to perform emergency care. So Taxi drivers should be encouraged more to undertake and maintain first-aid training. For more volunteering of first-aid training and improvement in the effect of first-aid training, a graded education program for taxi drivers with a low level of education should be developed, and a policy on giving credit for completing first-aid training course and for carrying out first-aid needs to be formulated.; Summary

Management of Cerebrospinal Fluid Leak after Traumatic Cervical Spinal Cord Injury: Soo Eon Lee, Chun Kee Chung, Tae Ahn Jahng, Chi Heon Kim; J Trauma Inj. 2013;26(3):151-156.

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Abstract PDF: PURPOSE
Traumatic cervical SCI is frequently accompanied by dural tear and the resulting cerebrospinal fluid (CSF) leak after surgery can be troublesome and delay rehabilitation with increasing morbidity. This study evaluated the incidence of intraoperative CSF leaks in patients with traumatic cervical spinal cord injury (SCI) who underwent anterior cervical surgery and described the reliable management of CSF leaks during the perioperative period.
METHODS
A retrospective study of medical records and radiological images was done on patients with CSF leaks after cervical spine trauma.
RESULTS
Seven patients(13.2%) were identified with CSF leaks during the intraoperative period. All patients were severely injured and showed structural abnormalities on the initial magnetic resonance image (MRI) of the cervical spine. Intraoperatively, no primary repair of dural tear was attempted because of a wide, rough defect size. Therefore, fibrin glue was applied to the operated site in all cases. Although a wound drainage was inserted, it was stopped within the first 24 hours after the operation. No lumbar drainage was performed. Postoperatively, the patients should kept their heads in an elevated position and early ambulation and rehabilitation were encouraged. None of the patients developed complications related to CSF leaks during admission.
CONCLUSION
The incidence of CSF leaks after surgery for cervical spinal trauma is relatively higher than that of cervical spinal stenosis. Therefore, one should expect the possibility of a dural tear and have a simple and effective management protocol for CSF leaks in trauma cases established.; 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.

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Abstract 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

Anatomic Conformity of New Periarticular Locking Plates for Koreans: A Biomechanical Cadaveric Study: Yong Cheol Yoon, Jong Keon Oh, Young Woo Kim, Hak Jun Kim, Hong Joo Moon, Nam Ryeol Kim; J Trauma Inj. 2013;26(3):163-169.

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Abstract PDF: PURPOSE
This study was conducted to confirm the anatomic conformity of the new periarticular locking plates designed by Zimmer on Korean adult bones and to identify the structures at risk during the application of these implants.
METHODS
The study was performed on the humerus, radius, and tibia of 10 adult cadavers(6 males and 4 females) procured from the cadaveric lab of our hospital. Anteroposterior (AP) and lateral X-rays were taken to confirm that the cadavers were free of any unusual lesions or anatomic variations. We used the 3.5-mm proximal humerus plate, 2.7-mm distal radius plate, 3.5- and 5.0-mm proximal tibia plates, and 3.5-mm distal tibia plate developed by Zimmer, Inc. (Zimmer periarticular locking plate). The longest plate from each group was used to confirm anatomical conformity. Standard approaches were used for each area, and soft tissue was retracted in order to pass the plate beneath the muscle. The position of the plate was confirmed using standard AP and lateral view X-rays. After this procedure had been completed, the region was dissected along the length of the implant to determine the conformity of the implant to bone and the penetrations of screws into the articular surface or violations of any vital structures, such as nerves, blood vessels, or tendons.
RESULTS
Excellent anatomical conformity was observed with Zimmer periarticular locking plates for Korean adults. The tibial nerve and the posterior tibial artery were found to be structures at risk when applying a distal tibial plate.
CONCLUSION
Additional posterolateral fixation is recommended when dealing with cases of tibial plateau fracture when the fracture line extends to the posterolateral cortex. We recommend taking proper views using 10~15 degrees of internal rotation to ensure correct screw length and, thus, avoid penetration of vital structures and tendons.; Summary

Comparison of Rib Fracture Location for Morbidity and Mortality in Flail Chest: Chun Sung Byun, Il Hwan Park, Geum Suk Bae, Pil Yeong Jeong, Joong Hwan Oh; J Trauma Inj. 2013;26(3):170-174.

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Abstract PDF: PURPOSE
A flail chest is one of most challenging problems for trauma surgeons. It is usually accompanied by significant underlying pulmonary parenchymal injuries and mayled to a life-threatening thoracic injury. In this study, we evaluated the treatment result for a flail chest to determine the effect of trauma localization on morbidity and mortality.
METHODS
Between 2004 and 2011, 46 patients(29 males/17 females) were treated for a flail chest. The patients were divided into two group based on the location of the trauma in the chest wall; Group I contained patients with an anterior flail chest due to a bilateral costochondral separation (n=27) and Group II contained patients with a single-side posterolateral flail chest due to a segmental rib fracture (n=19). The location of the trauma in the chest wall, other injuries, mechanical ventilation support, prognosis and ISS (injury severity score) were retrospectively examined in the two groups.
RESULTS
Mechanical ventilation support was given in 38 patients(82.6%), and 7 of these 38 patients required a subsequent tracheostomy. The mean ISS for all 46 patients was 19.08+/-10.57. Between the two groups, there was a significant difference in mean ventilator time (p<0.048), but no significant difference in either trauma-related morbidity (p=0.369) or mortality (p=0.189).
CONCLUSION
An anterior flail chest frequently affects the two underlying lung parenchyma and can cause a bilateral lung contusion, a hemopneumothorax and lung hemorrhage. Thus, it needs longer ventilator care than a lateral flail chest does and is more frequently associated with pulmonary complications with poor outcome than a lateral flail chest is. In a severe trauma patient with a flail chest, especially an anterior flail chest, we must pay more attention to the pulmonary care strategy and the bronchial toilet.; Summary

Car-tire-related Crushing Injury of the Lower Leg in Children: Jaeyeon Choi, Jaeho Jang, Jaehyuck Woo, Wonbin Park, Jinjoo Kim, Sungyeol Hyun, Geun Lee, Jeehoon Gwak; J Trauma Inj. 2013;26(3):175-182.

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Abstract PDF: PURPOSE
Crushing injuries by car tires result from a combination of friction, shearing, and compression forces and the severity of injury is influenced by the acceleration. Because car-tire injuries of the lower leg in children are common these days but they have received little attention; thus, our purpose was to look closely into this problem.
METHODS
A retrospective analysis was conducted of data from children under 15 years old age who visited an emergency department because of a car-tire-related crushing injury to the lower leg in pedestrian traffic accident from January 2008 to September 2012. The patient's age, sex, site of injury, degree of injury, associated injuries, type of surgery, and complications were reviewed.
RESULTS
There were 39 children, the mean age was 8.0 years, and 71.8% were boys. The dorsal part of the leg was involved most frequently. According to the severity classification, 15 children were grade I, 6 were grade II, and 18 were grade III. Among 24 patients, 13 were treated with skin graft and 3 were treated using a sural flap. Twelve patients developed complications, such as hypertrophic scarring, contractures, and deformities with significant bone loss.
CONCLUSION
Various degrees of skin or soft tissue defects were caused in children by car tires. In this study, patients were often also had tendon or bone damage. Proper and timely initial treatments are needed to reduce the incidence of infection, the number of operative procedures, and the hospital stay.; Summary

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