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J Trauma Inj : Journal of Trauma and Injury

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Volume 31(2); 2018
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Original Articles
Clinical Outcomes of Diffuse Axonal Injury According to Radiological Grade
Hak-Jae Lee, Hyun-Woo Sun, Jae-Seok Lee, Nak-Joon Choi, Yoon-Joong Jung, Suk-Kyung Hong
J Trauma Inj. 2018;31(2):51-57.   Published online August 31, 2018
DOI: https://doi.org/10.20408/jti.2018.31.2.51
  • 18,108 View
  • 302 Download
  • 5 Citations
AbstractAbstract PDF
Purpose

Patients with diffuse axonal injury experience various disabilities and have a high cost of treatment. Recent researches have revealed the underlying mechanism and pathogenesis of diffuse axonal injury. This study aimed to investigate the correlation between the radiological grading of diffuse axonal injury and the clinical outcomes of patients.

Methods

From January 2011 to December 2016, among 294 patients with traumatic brain injury, 44 patients underwent magnetic resonance imaging (MRI). A total of 18 patients were enrolled in this study except for other cerebral injuries, such as cerebral hemorrhage or hypoxic brain damage. Demographic data, clinical data, and radiological findings were retrospectively reviewed. The grading of diffuse axonal injury was analyzed based on patient’s MRI findings.

Results

For the most severe diffuse axonal injury patients, prolonged intensive care unit (ICU) stay (p=0.035), hospital stay (p=0.012), and prolonged mechanical ventilation (p=0.030) were observed. However, there was no significant difference in healthcare-associated infection rates between MRI grading (p=0.123). Massive transfusion, initial hemoglobin and lactate levels, and MRI gradings were found to be highly significant in predicting the duration of unconsciousness.

Conclusions

This study showed that patients with high grade diffuse axonal injury have prolonged ICU stays and significantly longer hospital stays. Deteriorated mental patients with high energy injuries should be evaluated to identify diffuse axonal injuries by using an appropriate imaging tool, such as MRI. It will be important to predict the duration of consciousness recovery using MRI scans.

Summary

Citations

Citations to this article as recorded by  
  • Prediction for the prognosis of diffuse axonal injury using automated pupillometry
    Makoto Murase, Shinichi Yasuda, Makoto Sawano
    Clinical Neurology and Neurosurgery.2024; 240: 108244.     CrossRef
  • Head CT for the intensivist: 10 tips and pearls
    Sajeev A. MAHENDRAN, Oliver FLOWER, J. Claude HEMPHILL III rd
    Minerva Anestesiologica.2022;[Epub]     CrossRef
  • Evaluation of Laboratory Variables Related to Diffuse Axonal Injury: A Cross-sectional Study
    Masoud Hatefi, Khalil Komlakh
    Archives of Neuroscience.2022;[Epub]     CrossRef
  • Clinical outcomes of diffuse axonal injury after traumatic brain injury according to magnetic resonance grading
    Insu Lee, Kawngwoo Park, Tae Seok Jeong, Woo-Seok Kim, Woo Kyung Kim, Do Yeon Rhee, Cheol Wan Park
    Journal of Korean Society of Geriatric Neurosurger.2021; 16(2): 71.     CrossRef
  • Use of Magnetic Resonance Imaging in Acute Traumatic Brain Injury Patients is Associated with Lower Inpatient Mortality
    Hwan Lee, Yifeng Yang, Jiehui Xu, Jeffrey B. Ware, Baogiong Liu
    Journal of Clinical Imaging Science.2021; 11: 53.     CrossRef
PARK Formula Can Replace “Guide to Medical Certificate” Published by Korean Medical Association in Deciding the Treatment Duration
Chan Yong Park, Kwang Hee Yeo, Sora Ahn
J Trauma Inj. 2018;31(2):58-65.   Published online August 31, 2018
DOI: https://doi.org/10.20408/jti.2018.31.2.58
  • 3,704 View
  • 63 Download
AbstractAbstract PDF
Purpose

Many doctors have difficulty in deciding the treatment duration in trauma patients to write in the casualty medical certificate. We tried to find a solution for this problem by using abbreviated injury scale (AIS).

Methods

A total of 39 patients treated in our regional trauma center who requested an author to write treatment duration on casualty medical certificate from January 2014 to April 2017 were included. And the treatment duration was decided based on the PARK Formula (AIS). PARK Formula (AIS)=(AIS×2) ~ ([AIS×2]+2)

Results

Among 39 patients included and 36 (92.3%) had treatment duration on casualty medical certificate within the range of treatment duration calculated by PARK Formula (AIS). Compared to the PARK Formula (AIS), the mean value was 0.13 week (0.90 day) smaller. Comparing the treatment duration between Korean Medical Association (KMA) guideline and PARK Formula (AIS), only 22 patients (56.4%) showed agreement. The mean value was 1.02 week (7.18 days) smaller in KMA guideline.

Conclusions

For the decision of the treatment duration in trauma patients, utilizing worldwide used AIS scoring system is very efficient. Using PARK Formula (AIS), doctors can document the treatment duration in the casualty medical certificate with ease. KMA should provide more practical ‘treatment duration of each diagnosis in writing casualty medial certificate’ for the doctors. We recommend PARK Formula (AIS) as a good alternative for KMA guide.

Summary
Case Reports
Endovascular Salvage for Traumatic Midthoracic Aortic Rupture with Left Diaphragmatic Injury
Shin-Ah Son, Tak-Hyuk Oh, Gun-Jik Kim, Deok Heon Lee, Kyoung Hoon Lim
J Trauma Inj. 2018;31(2):66-71.   Published online August 31, 2018
DOI: https://doi.org/10.20408/jti.2018.31.2.66
  • 3,374 View
  • 24 Download
AbstractAbstract PDF

Patients with traumatic aortic rupture rarely reach the hospital alive. Even among those who arrive at the hospital alive, traumatic aortic rupture after high-speed motor vehicle accidents leads to a high in-hospital mortality rate and is associated with other major injuries. Here, we report a rare case of descending midthoracic aortic rupture with blunt diaphragmatic rupture. Successful management with emergency laparotomy after an immediate endovascular procedure resulted in a favorable prognosis in this case.

Summary
Pulmonary Thromboembolism during Acetabular Fracture Operation
Il Seo, Chang-Wug Oh, Joon-Woo Kim, Kyeong-Hyun Park
J Trauma Inj. 2018;31(2):72-75.   Published online August 31, 2018
DOI: https://doi.org/10.20408/jti.2018.31.2.72
  • 4,226 View
  • 81 Download
AbstractAbstract PDF

Acetabular and Pelvic ring fractures are major high-energy trauma injuries and are often combined with other injuries. In particular, cause of long duration of immobilization and combined injuries, venous thromboembolism is a common complication in trauma patients with pelvic or acetabular fractures. We report a case of a fatal pulmonary thromboembolism during the acetabulum fracture operation in a 62-year-old male patient.

Summary
Non-Operatively Treated Thoracolumbar Burst Fracture with Posterior Ligamentous Complex Injury: Case Report and Consideration on the Limitation of Thoracolumbar Injury Classification and Severity (TLICS) Score
Woo-Keun Kwon, Jong-Keon Oh, Jun-Min Cho, Taek-Hyun Kwon, Youn-Kwan Park, Hong Joo Moon, Joo Han Kim
J Trauma Inj. 2018;31(2):76-81.   Published online August 31, 2018
DOI: https://doi.org/10.20408/jti.2018.31.2.76
  • 3,985 View
  • 63 Download
  • 1 Citations
AbstractAbstract PDF

Fractures at the thoracolumbar region are commonly followed after major traumatic injuries, and up to 20% of these fractures are known to be burst fractures. Making surgical decisions for these patients are of great interest however there is no golden standard so far. Since the introduction of Thoracolumbar Injury Classification and Severity (TLICS) score in 2007, it has been widely used as a referential guideline for making surgical decisions in thoracolumbar fractures. However, there is still limitations in this system. In this clinical case report, we introduce a L1 burst fracture after motor vehicle injury, who was successfully treated conservatively even while she was graded as a TLICS 5 injury. A case report is presented as well as discussion on the limitations of this grading system.

Summary

Citations

Citations to this article as recorded by  
  • Nonoperative Management in Intact Burst Fracture Patient With Thoracolumbar Injury Classification and Severity Score of 5: A Case Report
    Gersham J Rainone, Yash Patel, Cody Woodhouse, Ryan Sauber, Alexander Yu
    Cureus.2022;[Epub]     CrossRef
Experience of Penetrating Gunshot Wound on Head in Korea
Hong Rye Kim, Seung Je Go, Young Hoon Sul, Jin Bong Ye, Jin Young Lee, Jung Hee Choi, Seoung Myoung Choi, Yook Kim, Su Young Yoon
J Trauma Inj. 2018;31(2):82-86.   Published online August 31, 2018
DOI: https://doi.org/10.20408/jti.2018.31.2.82
  • 6,985 View
  • 64 Download
  • 1 Citations
AbstractAbstract PDF

Craniocerebral gunshot injuries (CGIs) are extremely seldom happened in Korea because possession of individual firearm is illegal. So, CGIs are rarely encountered by Korean neurosurgeons or Korean trauma surgeons, though in other developing countries or Unites states of America their cases are indefatigably increasing. Management goal should focus on early aggressive, vigorous resuscitation. The treatments consist of immediate life salvage through correction of coagulopathy, intracranial decompression, prevention of infection and preservation of nervous tissue. There have been few studies involving penetrating CGIs in Korea. Here we present a case of penetrating gunshot wound in Korea. We present a 58-year-old man who was unintentionally shot by his colleague with a shotgun. The patients underwent computed tomography (CT) for assessment of intracranial injury. The bullet passed through the left parietal bone and right lateral ventricle and exited through the posterior auricular right temporal bone. After CT scan, he arrested and the cardiopulmonary resuscitation was conducted immediately. But we were unable to resuscitate him. This case report underscores the importance of the initial clinical exam and CT studies along with adequate resuscitation to make the appropriate management decision. Physicians should be familiar with the various injury patterns and imaging findings which are poor prognostic indicators.

Summary

Citations

Citations to this article as recorded by  
  • Civilian penetrating traumatic brain injury: A 5-year single-center experience
    Omid Yousefi, Pouria Azami, Roham Borazjani, Amin Niakan, Mahnaz Yadollahi, Hosseinali Khalili
    Surgical Neurology International.2023; 14: 28.     CrossRef
Splenic Autotransplantation after Blunt Spleen Injury in Children
Hojun Lee, Byung Hee Kang, Junsik Kwon, John Cook-Jong Lee
J Trauma Inj. 2018;31(2):87-90.   Published online August 31, 2018
DOI: https://doi.org/10.20408/jti.2018.31.2.87
  • 4,530 View
  • 78 Download
  • 1 Citations
AbstractAbstract PDF

Non-operative management has been preferred in blunt spleen injury. Moreover children are more susceptible to post-splenectomy infection, spleen should be preserved if possible. However, splenectomy is inevitable to patients with severe splenic injury. Therefore splenic autotransplantation could be the last chance for preserving splenic function in these patients although efficacy has not proven. Here we reported four cases of children who were underwent splenic autotransplantation successfully after blunt trauma.

Summary

Citations

Citations to this article as recorded by  
  • Stumpfes Bauchtrauma bei Kindern und Jugendlichen: Behandlungskonzepte in der Akutphase
    M. C. Schunn, J. Schäfer, F. Neunhoeffer, J. Lieber, J. Fuchs
    Die Chirurgie.2023; 94(7): 651.     CrossRef
Reconstruction of a Large Infected Midline Abdominal Wall Defect Using a Latissimus Dorsi Free Flap
Han Gyu Cha, Eun Key Kim, Suk-Kyung Hong
J Trauma Inj. 2018;31(2):91-95.   Published online August 31, 2018
DOI: https://doi.org/10.20408/jti.2018.31.2.91
  • 3,959 View
  • 59 Download
AbstractAbstract PDF

Managing large infected midline abdominal defects are clinically challenging and technically demanding. The alloplastic materials, regional flaps, and component separation are usually infeasible because of the size, location, depth, and state of the defects. In these cases, the free flap is the only option with a large well-vascularized tissue that is free to inset regardless of the location. Herein, we report a case of 44-year-old man with a large infected midline abdominal wall defect who was completely treated with a latissimus dorsi myocutaeous free flap followed by negative pressure wound therapy.

Summary
Surgical Treatment of Ipsilateral Multi-Level Femoral Fracture Treated Using Antegrade Intramedullary Nail
Beom-Soo Kim, Jae-Woo Cho, Do-Hyun Yeo, Jong-Keon Oh
J Trauma Inj. 2018;31(2):96-102.   Published online August 31, 2018
DOI: https://doi.org/10.20408/jti.2018.31.2.96
  • 11,306 View
  • 268 Download
AbstractAbstract PDF

Ipsilateral fractures of proximal femur with shaft and condylar region are very rare. Current concept of management is based on fixation of each fracture as independent entity using separate fixation modalities for proximal and distal parts of femur. However, we considered that antegrade femoral nailing with cephalomedullary screw fixation is a good option for ipsilateral multi-level femoral fractures. Here, we present an experience of satisfactory treatment for ipsilateral femoral neck fracture, subtrochanteric fracture, comminuted shaft fracture with supracondylar fracture following road traffic accident.

Summary
Rare Imaging of Fat Embolism Seen on Computed Tomography in the Common Iliac Vein after Polytrauma
Hojun Lee, Jonghwan Moon, Junsik Kwon, John Cook-Jong Lee
J Trauma Inj. 2018;31(2):103-106.   Published online August 31, 2018
DOI: https://doi.org/10.20408/jti.2018.31.2.103
  • 4,852 View
  • 61 Download
  • 1 Citations
AbstractAbstract PDF

Fat embolism refers to the presence of fat droplets within the peripheral and lung microcirculation with or without clinical sequelae. However, early diagnosis of fat embolism is very difficult because the embolism usually does not show at the computed tomography as a large fat complex within vessels. Forty-eight-year-old male with pedestrian traffic accident ransferred from a local hospital by helicopter to the regional trauma center by two flight surgeons on board. At the rendezvous point, he had suffered with dyspnea without any airway obstruction sign with 90% of oxygen saturation from pulse oximetry with giving 15 L of oxygen by a reserve bag mask. The patient was intubated at the rendezvous point. The secondary survey of the patient revealed multiple pelvic bone fracture with sacrum fracture, right femur shaft fracture and right tibia head fracture. Abdominal computed tomography was performed in 191 minutes after the injury and fat embolism with Hounsfield unit of ?86 in his right common iliac vein was identified. Here is a very rare case that mass of fat embolism was shown within common iliac vein detected in computed tomography. Early detection of the fat embolus and early stabilization of the fractures are essential to the prevention of sequelae such as cerebral fat embolism.

Summary

Citations

Citations to this article as recorded by  
  • Fat embolism in the popliteal vein detected on CT: Case report and review of the literature
    Tucker Burr, Hamza Chaudhry, Cheryl Zhang, Vasilios Vasilopoulos, Emad Allam
    Radiology Case Reports.2020; 15(11): 2308.     CrossRef
Bone Transport over the Plate for the Segmental Bone Defect of Tibia
Il Seo, Chang-Wug Oh, Joon-Woo Kim, Kyeong-Hyun Park
J Trauma Inj. 2018;31(2):107-111.   Published online August 31, 2018
DOI: https://doi.org/10.20408/jti.2018.31.2.107
  • 5,399 View
  • 105 Download
AbstractAbstract PDF

Segmental bone defects of the tibia present a challenging problem for the orthopedic trauma surgeon. These injuries are often complicated by soft tissue defects and infection. Many techniques are reported, from bone graft to bone transport. To our knowledge, bone transport over the plate in the distraction site has not been described for the treatment of tibial bone defect. We report an instance including procedure and subsequent complications after bone transport over the plate, to restore a tibial bone defect.

Summary
Calcaneal Fractures: A Soft Tissue Emergency
Tae-Seong Kim, Chang-Wug Oh, Joon-Woo Kim, Kyung-Hyun Park
J Trauma Inj. 2018;31(2):112-116.   Published online August 31, 2018
DOI: https://doi.org/10.20408/jti.2018.31.2.112
  • 9,079 View
  • 98 Download
AbstractAbstract PDF

Calcaneal fractures are quite often seen in patients with axial loading injury. In the tongue-type of calcaneusal fractures or tuberosity avulsion fractures, bone fragments are often superiorly and posteriorly displaced, because of the insertion of the Achilles tendon and pull of the gastroc-soleus complex. The Ddisplaced bone fragment compresses the soft tissues, leading tothat makes skin necrosis. To prevent further soft tissue injury, early recognition of the injury by the emergency physician and immediate orthopedic consultation is needed.

Summary

J Trauma Inj : Journal of Trauma and Injury