Journal of Trauma and Injury

Volume 27(2); June 2014

Original Articles

Factors Associated with Radiologic Tests in Patients with Radial Head Subluxation: Ikwan Chang, Do Kyun Kim, So Young Park, Dongbum Suh, Jae Yun Jung, Young Ho Kwak; J Trauma Inj. 2014;27(2):13-19.

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Abstract PDF: PURPOSE
In general, X-ray examinations are not recommended for radial head subluxation (pulled elbow) patients. The purpose of this study was to determine the frequency of X-ray examinations and to investigate the factors associated with the decision to perform an X-ray examination on a patient with a pulled elbow.
METHODS
Patients who visited the pediatric emergency department (ED) of one tertiary hospital from January 1, 2011, to December 31, 2012, with a diagnosis of radial head subluxation at discharge were enrolled in this study. Through retrospective chart reviews, factors that could have influenced the decision to perform an X-ray examination and their statistical relevance were analyzed.
RESULTS
A total 308 patients were enrolled, and 101 patients (32.8%) underwent X-ray examinations. Among the 252 patients with a typical pulled elbow, 65 underwent X-ray examination. This result showed statistical significance compared to atypical pull-elbow group (25.8% vs. 64.3%, p<0.001). Factors associated with the decision to perform an X-ray examination were analyzed using the Chi-square test and the Fisher's exact test. The mechanism of injury and consultation with an orthopedic surgeon (p=0.001) showed statistical significance. In the multivariable logistic regression, the odds ratio (OR) for the injury mechanism was 4.7 (95% CI: 1.8~8.8, p<0.001) and that for consultation with an orthopedic surgeon was 8.0 (95% CI: 1.6~40.7, p=0.004).
CONCLUSION
One third of patients with a pulled elbow underwent X-ray examination, and patients with an atypical mechanism of injury underwent more frequent X-ray examinations than did patients with a typical mechanism of injury. The factors that could have influenced the decision to perform an X-ray examination were mechanism of injury and consultation with an orthopedic surgeon.; Summary

The Thermal Insulation of Warm Fluid using Aluminium Foil in Trauma Care: Seo Jin Kim, Kyung Hoon Sun, Yong Jin Park, Sun Pyo Kim; J Trauma Inj. 2014;27(2):20-24.

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Abstract PDF: PURPOSE
The temperature of a warm fluid infused into a patient is lowered because the line that allows the fluid to be infused into the patient is exposed to room air. This study evaluated the effects of aluminum foil used as an insulator surrounding the fluid infusion lines when using warm crystalloid fluids to treat traumatic shock patients.
METHODS
The study measured the differences in fluid temperature between infusion lines with and without the aluminum-foil insulation. We used 1L of normal saline at 40degrees C as the infusion fluid, and the fluid infusion line was 200 cm long. The differences in temperature were measured for various fluid flow rates from 12,000 mL/min to 100 mL/min. We performed three experiments at each flow rate.
RESULTS
The results showed the differences in temperature between the groups with and without the aluminum insulation were significant for flow rates above 100 mL/min.
CONCLUSION
Hypothermia in trauma patients results in many adverse complications such as peripheral vascular constriction, tissue hypoxia, metabolic acidosis, heart dysfunction and so on. Thus, the use of warm fluids and blood components is essential to reduce the probability of hypothermia. This study showed the aluminum foil wrapped around the infusion line had an insulator effect. As a result, such a wrapping can be used to avoid the adverse effects of hypothermia.; Summary

Case Reports

Severe Open Ankle Sprain (SOAS): A Case Report: Sung Hyun Yoon, Chang Hwan Hwang; J Trauma Inj. 2014;27(2):25-28.

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Abstract PDF: Ankle injury is a very common injury. Especially it is the most commonly injured site in cases sports injuries. However, severe open ankle sprain (SOAS), defined as the tearing of the skin over the torn ligament in the ankle, is extremely rare, and no cases have been reported in Korea. In our center, we encountered a patient with a severe ankle open sprain, so we report and discuss that case.; Summary

Retroperitoneal Gauze Packing with Vacuum-Associated Closure for Pelvic Fracture with Hemodynamic Instability: Sung Jeep Kim, Ji Hoon T Kim; J Trauma Inj. 2014;27(2):29-32.

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Abstract PDF: Pelvic bone fracture with hemodynamic instability is fatal and the mortality rate can range up to 40%. Despite the big advances in the treatment of massive bleeding and hemorrhagic shock, the mortality associated with hemodynamically unstable pelvic bone fractures remains high. The gold standard of treatment for pelvic bone fracture with hemodynamic instability has not yet been determined and is an issue of main discussion among many doctors. Retroperitoneal packing is not yet wide spread in Korea, but is a good modality for managing of massive bleeding from pelvic bone fractures when an angiography suite or an expert surgeon is not available. A vacuum-assisted closure (VAC) system can also be applied with retroperitoneal packing in the manner of damage control surgery and open abdomen surgery. We present the case of a 51-year-old male who had a pelvic bone fracture with massive bleeding. We performed retroperitoneal gauze packing with a VAC system for the first time. The postoperative vital signs of patient were immediately stable, the massive bleeding was easily and quickly controlled, and the amount of transfusion of blood components was reduced.; Summary

Accidental Vertebral Artery Cannulation as a Complication of the Central Venous Catherization: Ju Ho Jeong; J Trauma Inj. 2014;27(2):33-37.

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Abstract PDF: Central venous catheterization through a subclavian approach is indicated for some special purposes but it may cause many complications such as infection, bleeding, pneumothorax, thrombosis, air embolization, arrhythmia, myocardial perforation, and nerve injury. A case involving a mistaken central venous catheterization into the right vertebral artery through the subclavian artery is presented. A 33-year-old man who had deteriorated mentality after head injury underwent an emergency craniotomy for acute epidural hematomas on the right frontal and temporal convexities. His mentality improved rapidly, but he complained of continuous severe pain in the right posterior neck even though he had no previous symptom or past medical history of such pain. Three-dimensional cervical spine computed tomography (3D-CT) was performed first to rule out unconfirmed cervical injuries and it revealed a linear radiopaque material intrathoracically from the level of the 1st rib up to the level of C6 in the right vertebral foramen. An additional neck CT was performed, and the subclavian catheter was indwelling in the right vertebral artery through right subclavian artery. For the purpose of proper fluid infusion and central venous pressure monitoring, the subclavian vein catheterization had been performed in the operation room after general anesthesia induction before the craniotomy. Sufficient anatomical consideration and prudence is essential because inadvertent arterial cannulation at a non-compressible site is a highly risky iatrogenic complication of central venous line placement.; Summary

Delayed Presentarion of Traumatic Diaphragmatic Rupture: Young Hoon Sul, Jae Young Moon, Kyung Ha Lee, Sang Il Lee, Kwang Sik Cheon, Jun Wan Lee, In Sang Song; J Trauma Inj. 2014;27(2):38-42.

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Abstract PDF: Traumatic diaphragmatic rupture is quite uncommon and rarely lethal injury. However, delayed presentation between the injury and the diagnosis can cause a life-threatening condition with various complications such as intestinal hernia, obstruction, strangulation, respiratory distress. Here, we present a case of delayed presentation of traumatic diaphragmatic rupture in a 51-year-old man, and then discuss about the clinical implication of delayed presentation of diaphragmatic rupture with a review.; Summary

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