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Volume 32(2); June 2019
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Original Articles
Comparison of the Surgical Approaches for Frontal Traumatic Intracerebral Hemorrhage
Eun Sung Park, Seong Keun Moon, Ki Seong Eom
J Trauma Inj. 2019;32(2):71-79.   Published online June 30, 2019
DOI: https://doi.org/10.20408/jti.2019.002
  • 4,343 View
  • 88 Download
  • 4 Citations
AbstractAbstract PDF
Purpose

Recent developments in minimally invasive techniques have the potential to reduce surgical morbidity, promote patient recovery, accelerate surgical procedures, and thus improve cost-effectiveness in case management. In this study, we compared the treatment efficacy and results of supraorbital keyhole approach (SOKA) with those of conventional unilateral frontal craniotomy (CUFC) for traumatic intracerebral hemorrhage (TICH) in the frontal lobe.

Methods

We analyzed the data of 38 patients who underwent CUFC (n=30) and SOKA (n=8) and retrospectively reviewed their medical records and radiological findings. Furthermore, we tried to identify the best surgical method for such lesions by including patients who underwent burr hole aspiration and drainage (BHAD) (n=9) under local anesthesia due to various circumstances.

Results

The difference in the initial Glasgow coma scale score, operative time, and length of hospitalization between the CUFC and SOKA were statistically significant. All radiological features between the two groups including associated skull fracture, amount of pre- and postoperative hematoma, percentage of complete hematoma removal, pre- and postoperative midline shifting of the hematoma, and development of postoperative delayed hematoma were not statistically significant. Our experience of 46 patients with TICH in the frontal lobe with any of the three different surgical methods including BHAD enabled us to obtain valuable findings.

Conclusions

Although it is difficult to insist that one particular approach is more useful than the other, we are confident that SOKA will have more advantages over CUFC in carefully selected patients with frontal TICH depending on the surgical experience of a neurosurgeon.

Summary

Citations

Citations to this article as recorded by  
  • Applications of supraorbital keyhole craniotomy in pediatric cranial trauma: illustrative series of two cases and systematic literature review
    Joshua J. Loya, Chenyi Yang, Zach Pennington, Nolan J. Brown, Ali I. Rae, Jesse L. Winer
    Child's Nervous System.2023; 39(12): 3531.     CrossRef
  • A Study to Evaluate Prognostic Factors and Define a Critical Volume for Early Surgery in Patients with Bifrontal Brain Contusions
    Manoranjitha Kumari M, T.P. Jeyaselva Senthilkumar, Yamunadevi Ravi
    Indian Journal of Neurosurgery.2023;[Epub]     CrossRef
  • Supraorbital eyebrow approach: A single-center experience
    Blessing Ndlovu, Mohammed Ouwais Abdul Sattar, Mlamuli Mzamo Mkhaliphi, Keletso Leola, Morena Nthuse Mpanza, John Richard Ouma, Christos Profyris
    Surgical Neurology International.2022; 13: 566.     CrossRef
  • Re: Comparison of the Surgical Approaches for frontal Traumatic Intracerebral Hemorrhage
    Luis Rafael Moscote-Salazar, Ezequiel Garcia-Ballestas, Pradeep Chouksey, Amit Agrawal
    Journal of Trauma and Injury.2020; 33(1): 59.     CrossRef
Comparison of Magnetic Resonance Imaging and Operation Waiting Times in Patients Having Traumatic Cervical Spinal Cord Injury; with or without Bony Lesions
Jeong Heo, Woo-Kie Min, Chang-Wug Oh, Joon-Woo Kim, Kyeong-hyeon Park, Il Seo, Eung-Kyoo Park
J Trauma Inj. 2019;32(2):80-85.   Published online June 30, 2019
DOI: https://doi.org/10.20408/jti.2019.004
  • 3,836 View
  • 55 Download
AbstractAbstract PDF
Purpose

To compare the time intervals to magnetic resonance imaging (MRI) and surgical treatment in patients having traumatic cervical spinal cord injury (SCI) with and without bony lesions.

Methods

Retrospectively analyzed adult patients visited Kyungpook National University Hospital and underwent surgical treatment for cervical SCI within 24 hours. The patients who were suspected of having cervical SCI underwent plain radiography and computed tomography (CT) upon arrival. After the initial evaluation, we evaluated the MRI findings to determine surgical treatment. Waiting times for MRI and surgery were evaluated.

Results

Thirty-four patients were included. Patients’ mean age was 57 (range, 23-80) years. Patients with definite bony lesions were classified into group A, and 10 cases were identified (fracture-dislocation, seven; fracture alone, three). Patients without bony lesions were classified into group B, and 24 cases were identified (ossification of the posterior longitudinal ligament, 16; cervical spondylotic myelopathy, eight). Mean intervals between emergency room arrival and start of MRI were 93.60 (±60.08) minutes in group A and 313.75 (±264.89) minutes in group B, and the interval was significantly shorter in group A than in group B (p=0.01). The mean times to surgery were 248.4 (±76.03) minutes in group A and 560.5 (±372.56) minutes in group B, and the difference was statistically significant (p=0.001). The American Spinal Injury Association scale at the time of arrival showed that group A had a relatively severe neurologic deficit compared with group B (p=0.046). There was no statistical significance, but it seems to be good neurological recovery, if we start treatment sooner among patients treated within 24 hours (p=0.198).

Conclusions

If fracture or dislocation is detected by CT, cervical SCI can be easily predicted resulting in MRI and surgical treatment being performed more rapidly. Additionally, fracture or dislocation tends to cause more severe neurological damage, so it is assumed that rapid diagnosis and treatment are possible.

Summary
Clinical Effects of Intra-Abdominal Pressure in Critically Ill Trauma Patients
Dong Yeon Ryu, Hohyun Kim, June Pill Seok, Chan Kyu Lee, Kwang-Hee Yeo, Seon-Uoo Choi, Jae-Hun Kim, Hyun Min Cho
J Trauma Inj. 2019;32(2):86-92.   Published online June 30, 2019
DOI: https://doi.org/10.20408/jti.2018.052
  • 3,748 View
  • 81 Download
AbstractAbstract PDF
Purpose

There is increasing interest in intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) in critically ill patients. This study investigated the effects and outcomes of elevated IAP in a trauma intensive care unit (ICU) population.

Methods

Eleven consecutive critically ill patients admitted to the trauma ICU at Pusan National University Hospital Regional Trauma Center were included in this study. IAP was measured every 8?12 hours (intermittently) for 72 hours. IAP was registered as mean and maximal values per day throughout the study period. IAH was defined as IAP ≥12 mmHg. Abdominal compartment syndrome was defined as IAP ≥20 mmHg plus ≥1 new organ failure. The main outcome measure was in-hospital mortality.

Results

According to maximal and mean IAP values, 10 (90.9%) of the patients developed IAH during the study period. The Sequential Organ Failure Assessment (SOFA) score was significantly higher in patients with IAP ≥20 mmHg than in those with IAP <20 mmHg (16 vs. 5, p=0.049). The hospital mortality rate was 27.3%. Patients with a maximum IAP ≥20 mmHg exhibited significantly higher hospital mortality rates (p=0.006). Non-survivors had higher maximum and mean IAP values.

Conclusions

Our results suggest that an elevated IAP may be associated with a poor prognosis in critically ill trauma patients.

Summary
Vascular Injuries Due to Penetrating Missile Trauma in Anti-Terrorism Ops
Rishi Dhillan, Alok Bhalla, Sushil Kumar Jha, Hakam Singh, Aman Arora
J Trauma Inj. 2019;32(2):93-100.   Published online June 30, 2019
DOI: https://doi.org/10.20408/jti.2018.032
  • 4,184 View
  • 88 Download
AbstractAbstract PDF
Purpose

Penetrating vascular trauma though less common poses a challenge to all Surgeons. This study was designed to analyse the profile, management modalities of vascular trauma and the outcomes thereof at a Trauma Care Centre in a Tertiary care setting in hostile environment in India.

Methods

A prospective review of all patients with arterial and venous injuries being transferred to the Trauma Center at out Tertiary Care Center between June 2015 and May 2018 was done. Demographics, admission data, treatment, and complications were reviewed.

Results

There were a total of 46 patients with 65 vascular injuries, 39 arterial injuries and 26 venous injuries. The age range was 21 to 47 years. Nineteen patients had both arterial and venous injuries. A total of 42 cases presented within 12 hours of injury and complete arterial transections were found in 33 cases (80.49%). There were three mortalities (6.52%) and three amputations (8.33%). The overall limb salvage rate was 91.67% with popliteal artery being the commonest injured artery. Poor prognosticators for limb salvage were increasing time to present to the trauma centre, hypovolemic shock, multi-organ trauma and associated venous injuries.

Conclusions

Penetrating missile trauma leading to vascular injuries has not been widely reported. Attempting limb salvage even in cases with delayed presentation should be weighed with the threat to life before revascularisation and should preferably be done at a centre with vascular expertise. A team approach with vascular, orthopaedic, general surgeons, and critical care anaesthesiologists all aboard improve the outcomes manifold. Use of tourniquets and early fasciotomies have been emphasized as is the use of native veins as the bypass conduit. This is probably the largest study on penetrating Vascular trauma in anti-terrorism ops from the Indian subcontinent. It highlights the significance of prompt recognition and availability of vascular expertise in optimally managing cases of vascular trauma.

Summary
Essential Factors in Predicting the Need for Angio-Embolization in the Acute Treatment of Pelvic Fracture with Hemorrhage
Seok-Won Yang, Hee-Gon Park, Sung-Hyun Kim, Sung-Hyun Yoon, Seung-Gwan Park
J Trauma Inj. 2019;32(2):101-106.   Published online June 30, 2019
DOI: https://doi.org/10.20408/jti.2019.008
  • 3,196 View
  • 50 Download
AbstractAbstract PDF
Purpose

The purpose of this study was to determine the essential factors for prompt arrangement of angio-embolization in patients with pelvic ring fractures.

Methods

A total of 62 patients with pelvic ring fractures who underwent angio-embolization in Dankook University Hospital from March 2013 to June 2018 were retrospectively reviewed. There were 38 men and 24 women with a mean age of 59.8 years. The types of pelvic ring fractures were categorized according to the Tile classification. Patient variables included sex, initial hemoglobin concentration, initial systolic blood pressure, transfused packed red blood cells within 24 hours, Injury Severity Score (ISS), mortality rate, length of hospital stay, and time to angio-embolization.

Results

The most common pelvic fracture pattern was Tile type B (n=34, 54.8%). The mean ISS was 27.3±10.9 with 50% having an ISS ≥25. The mean time to angio-embolization from arrival was 173.6±89 minutes. Type B (180.1±72.3 minutes) and type C fractures (174.7±91.3 minutes) required more time to angio-embolization than type A fractures (156.6±123 minutes). True arterial bleeding was identified in types A (35.7%), B (64.7%), and C (71.4%).

Conclusions

It is important to save time to reach the angio-embolization room in treating patients with pelvic bone fractures. Trauma surgeons need to consider prompt arrangement of angio-embolization when encountering Tile type B or C pelvic fractures due to the high risk of true arterial bleeding.

Summary
Case Reports
Bilateral Chylothorax Due to Blunt Spine Hyperextension Injury: A Case Report
Hohyoung Lee, Sung Ho Han, Min Koo Lee, Oh Sang Kwon, Kyoung Hwan Kim, Jung Suk Kim, Soon-Ho Chon, Sung Ho Shinn
J Trauma Inj. 2019;32(2):107-110.   Published online June 30, 2019
DOI: https://doi.org/10.20408/jti.2018.050
  • 3,266 View
  • 55 Download
  • 1 Citations
AbstractAbstract PDF

Bilateral chylothorax due to blunt trauma is extremely rare. We report a 74-year-old patient that developed delayed bilateral chylothorax after falling off a ladder. The patient had a simple 12th rib fracture and T12 lamina fracture. All other findings seemed normal. He was sent home and on the 5th day visited our emergency center at Halla Hospital with symptoms of dyspnea and lower back pain. Computer tomography of his chest presented massive fluid collection in his right pleural cavity and moderate amounts in his left pleural cavity with 12th rib fracture and T11-12 intervertebral space widening with bilateral facet fractures. Chest tubes were placed bilaterally and chylothorax through both chest tubes was discovered. Conservative treatment for 2 weeks failed, and thus, thoracic duct ligation was done by video assisted thoracoscopic surgery. Thoracic duct embolization was not an option. Postoperatively, the patient is now doing well and happy with the results. Early surgical treatment must be considered in the old patient, whom large amounts of chylothorax are present.

Summary

Citations

Citations to this article as recorded by  
  • Thoracic duct injury: An up to date
    JoséLuis Ruiz Pier, MohebA Rashid
    The Journal of Cardiothoracic Trauma.2021; 6(1): 15.     CrossRef
Recurrence of Minimal Change Disease Following a Motor Vehicle Trauma: An Atypical Cause and Review of Literature
Jayaramakrishna Depa, George Coritsidis
J Trauma Inj. 2019;32(2):111-114.   Published online June 30, 2019
DOI: https://doi.org/10.20408/jti.2018.048
  • 3,224 View
  • 51 Download
AbstractAbstract PDF

Minimal change disease (MCD) in children has a favorable long-term prognosis, and development of end-stage renal disease is very uncommon; less than 5%. In the first case of its kind, we report a 21-year-old female with a history of MCD at the age of 6, who had late relapse subsequent to a motorcycle accident resulting in a de-gloving skin injury and intensive care unit admission. MCD was confirmed by normal light microscopy, podocyte effacement on electron microscopy and absence of any deposits on immunofluorescence 3 weeks after the incident due to critical illness. It is postulated that the skin injury is what caused the relapse of MCD.

Summary
Large Focal Extrapleural Hematoma of Chest Wall: A Case Report
Hohyoung Lee, Sung Ho Han, Min Koo Lee, Oh Sang Kwon, Kyoung Hwan Kim, Jung Suk Kim, Soon-Ho Chon, Sung Ho Shinn
J Trauma Inj. 2019;32(2):115-117.   Published online June 30, 2019
DOI: https://doi.org/10.20408/jti.2019.001
  • 4,903 View
  • 46 Download
AbstractAbstract PDF

Although hemothorax and pneumothorax are common complications seen in rib fractures, focal extrapleural hematoma is quite rare. We report a 63-year-old female patient that developed large focal extrapleural hematoma after falling off a second floor veranda. The patient had sustained 3, 4, 5th costal cartilage rib fractures and a sternum fracture. She had developed suspected empyema with loculations with small amount of hemothorax. She underwent a planned early decortication/adhesiolysis by video assisted thoracoscopic surgery at the 12th post-trauma day due to failed drainage. Unexpectedly, she had no adhesions or any significant retained hematoma mimicking a mass, but was found with the focal extrapleural chest wall hematoma. She was discharged on postoperative 46th day for other reasons and is doing fine today.

Summary
An Unusual Complication of Colonic Perforation Following Percutaneous Nephrostomy in a Grade IV Blunt Renal Injury Patient
Joan Gan Cheau Yan, Tan Jih Huei, Henry Tan Chor Lip, Yuzaidi Mohamad, Rizal Imran Alwi
J Trauma Inj. 2019;32(2):118-121.   Published online June 30, 2019
DOI: https://doi.org/10.20408/jti.2019.011
  • 3,535 View
  • 43 Download
AbstractAbstract PDF

Percutaneous nephrostomy is relatively safe for temporary urinary diversion. However, colonic perforation due to percutaneous nephrostomy can happen with an incidence of 0.2% as reported in the English literatures. To our knowledge, this is the first case being reported as a complication following treatment for traumatic renal injury. This paper is to share our treatment approach which differs from the usual approach according to existing literatures. We report on a young man who sustained grade IV renal injury due to blunt trauma and was managed conservatively. The treatment of traumatic renal injury via urinary diversion was complicated with an iatrogenic colonic perforation. The management and subsequent treatment of this patient is discussed in this case report.

Summary
The Successful Removal of a Foreign Body in the Spleen via Diaphragm Laceration Site by Video-Assisted Thoracoscopic Surgery
Yang Bin Jeon, Sung Youl Hyun, Dae Sung Ma
J Trauma Inj. 2019;32(2):122-125.   Published online June 30, 2019
DOI: https://doi.org/10.20408/jti.2018.055
  • 3,058 View
  • 80 Download
  • 1 Citations
AbstractAbstract PDF

A 73-year-old man, who, in an inebriated state, had slipped in a flowerbed and was wounded on the left flank, was transferred to Trauma Center, Gil Medical Center, Gachon University College of Medicine. Based on the chest and abdominopelvic computed tomography, he was diagnosed with multiple rib fractures and hemopneumothorax on the left hemithorax and was found to have a bony fragment in the spleen. He had not presented peritonitis and exsanguinous symptoms during the observation period. Seven days later, computed tomography of the abdomen showed suspected diaphragmatic injury and a retained foreign body in the spleen. On exploration by video assisted thoracoc surgery (VATS), a herniated omentum through the lacerated site of the diaphragm was observed. After omentectomy using Endo Gia, the foreign body in the spleen was observed through the lacerated site of the diaphragm. Traumatic diaphragm rupture with a foreign body, in the spleen, was successfully managed by video assisted thoracic surgery via the lacerated site of the diaphragm.

Summary

Citations

Citations to this article as recorded by  
  • The role of VATS in the removal of intrathoracic foreign bodies — a systematic review
    Fahmi Hussein Kakamad, Razhan Kawa Ali, Bnar Jamal Hama Amin, Shvan Hussein Mohammed, Diyar Adnan Omar, Karukh Khalid Mohammed, Sanaa Othman Karim, Suhaib Hussein Kakamad, Rawezh Qadir Mohammed Salih, Diyar Abubaker Mohammed, Abdulwahid Mohammed Salih, Mo
    Indian Journal of Thoracic and Cardiovascular Surg.2023; 39(2): 125.     CrossRef

J Trauma Inj : Journal of Trauma and Injury