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“Most viewed” articles are those published within the last 2 years (2022– ). The following are the most frequently accessed articles from Journal of Trauma and Injury.

Case Report
Successful minimally invasive management using transcatheter arterial embolization in a hemodynamically stable elderly patient with mesenteric vascular injury in a hybrid emergency room system in Korea: a case report
So Ra Ahn, Joo Hyun Lee, Sang Hyun Seo, Chan Yong Park
J Trauma Inj. 2023;36(4):435-440.   Published online July 25, 2023
DOI: https://doi.org/10.20408/jti.2023.0018
  • 1,105 View
  • 18 Download
AbstractAbstract PDF
Mesenteric injury occurs rarely in cases associated with blunt abdominal trauma. Despite its low incidence, mesenteric injury can lead to fatal outcomes such as hypovolemic shock due to hemoperitoneum or sepsis due to intestinal ischemia, or perforation-related peritonitis. For mesenteric injuries, especially those involving massive bleeding, intestinal ischemia, and perforation, the standard treatment is surgery. However, in the case of operative management, it should be borne in mind that there is a possibility of complications and mortality during and after surgery. The usefulness of transcatheter arterial embolization (TAE) is well known in solid organs but is controversial for mesenteric injury. We present a 75-year-old man with mesenteric injury due to blunt abdominal trauma. Initial abdominal computed tomography showed no hemoperitoneum, but a mesenteric contusion and pseudoaneurysm with a diameter of 17 mm were observed near the origin of the superior mesenteric artery. Since there were no findings requiring emergency surgery such as free air or intestinal ischemia, it was decided to perform nonoperative management with TAE using microcoils in hybrid emergency room system. TAE was performed successfully, and there were no complications such as bleeding, bowel ischemia, or delayed bowel perforation. He was discharged on the 23rd day after admission with percutaneous catheter drainage for drainage of mesenteric hematoma. The authors believe that treatment with TAE for highly selected elderly patients with mesenteric injuries has the positive aspect of minimally invasive management, considering the burden of general anesthesia and the various avoidable intraoperative and postoperative complications.
Summary
Original Articles
Distally based lateral supramalleolar flap for reconstructing distal foot defects in India: a prospective cohort study
Raja Kiran Kumar Goud, Palukuri Lakshmi, Sanujit Pawde, Madhulika Dharmapuri, Swati Sankar, Sandeep Reddy Chintha
J Trauma Inj. 2023;36(3):217-223.   Published online September 18, 2023
DOI: https://doi.org/10.20408/jti.2023.0005
  • 1,054 View
  • 54 Download
AbstractAbstract PDF
Purpose
Defects involving the ankle and foot are often the result of road traffic accidents. Many such defects are composite and require a flap for coverage, which is a significant challenge for reconstructive surgeons. Various locoregional options, such as reverse sural artery, reverse peroneal artery, peroneus brevis muscle, perforator-based, and fasciocutaneous flaps, have been used, but each flap type has limitations. In this study, we used the distally based lateral supramalleolar flap to reconstruct distal dorsal defects of the foot. The aim of this study was to analyze the efficacy of the flap in reconstructing distal dorsal defects of the foot. The specific objectives were to study the adequacy, reach, and utility of the lateral supramalleolar flap for distal defects of the dorsum of the foot; to observe various complications encountered with the flap; and to study the functional outcomes of reconstruction.
Methods
The distal dorsal foot defects of 10 patients were reconstructed with distal lateral supramalleolar flaps over a period of 6 months at a tertiary care center, and the results were analyzed.
Results
We were able to effectively cover distal foot defects in all 10 cases. Flap congestion was observed in two cases, and minor graft loss was seen in two cases.
Conclusions
The distally based lateral supramalleolar flap is a good pedicled locoregional flap for the coverage of distal dorsal foot and ankle defects of moderate size, with relatively few complications and little morbidity. It can be used as a lifeboat or even substitute for a free flap.
Summary
Sports injuries: a 5-year review of admissions at a major trauma center in the United Kingdom
Ahmad Hammad Hassan, Aref-Ali Gharooni, Harry Mee, James Geffner, Fahim Anwar
J Trauma Inj. 2023;36(1):39-48.   Published online July 14, 2022
DOI: https://doi.org/10.20408/jti.2021.0084
  • 2,804 View
  • 51 Download
AbstractAbstract PDF
Purpose
Sports offer several health benefits but are not free of injury risk. Activity dynamics vary across sports, impacting the injury profile and thereby influencing healthcare resource utilization and health outcomes. The purpose of this study was to investigate sports-related major trauma cases and compare differences across sports and activity groups.
Methods
A retrospective case notes review of sports-related major traumas over a 5-year period was conducted. Demographic, hospital episode-related, and health outcome-related data were analyzed, and differences were compared across sports and activity groups. The Glasgow Outcome Scale (GOS) at discharge was used as the primary outcome measure and the length of hospital stay as the secondary outcome measure.
Results
In total, 74.6% of cases had good recovery at discharge (GOS, 5), 18.9% had moderate disability (GOS, 4), and 3.7% had severe disability (GOS, 3). The mean length of hospital stay was 11.2 days (range, 1–121 days). The most severely injured body region was the limbs (29.1%) and vertebral/spinal injuries were most common in terms of location (51.8%). A significant difference (P<0.05) existed in GOS across sports groups, with motor sports having the lowest GOS. However, no significant differences (P>0.05) were found in other health-outcome variables or injury patterns across sports or activity groups, although more competitive sports cases (67.08%) required admission than recreational sports cases (32.9%).
Conclusions
Spinal injuries are the most frequent sports injuries, bear the worst health outcomes, and warrant better preventive measures. Head injuries previously dominated the worst outcomes; this change is likely due to better preventive and management modalities. Competitive sports had a higher injury frequency than recreational sports, but no difference in health outcomes or injury patterns.
Summary
Review Article
Delayed union of a pediatric lunate fracture in the United Kingdom: a case report and a review of current concepts of non-scaphoid pediatric carpal fractures
Timothy P. Davis, Elizabeth Headon, Rebecca Morgan, Ashley I. Simpson
J Trauma Inj. 2023;36(4):315-321.   Published online December 20, 2023
DOI: https://doi.org/10.20408/jti.2023.0038
  • 534 View
  • 21 Download
AbstractAbstract PDF
Pediatric carpal fractures are rare and often difficult to detect. This paper reviews the current literature on pediatric non-scaphoid carpal fractures, with a case report of a lunate fracture associated with a distal radius and ulnar styloid fracture, managed nonoperatively in a 12-year-old boy. There is lack of consensus regarding the management of these fractures due to the low number of reported cases. A frequent lack of long-term follow-up limits our understanding of the outcomes, but good outcomes have been reported for both nonoperative and operative management. This case report brings attention to the current time period for the definition of delayed union in pediatric carpal fractures, and emphasizes the need for prolonged follow-up for the detection of delayed complications leading to functional impairment.
Summary
Original Article
Proximally based sural artery flap for the reconstruction of soft tissue defects around the knee and proximal third of the leg in India: a clinical study
Palukuri Lakshmi, Sreedharala Srinivas, Dharmapuri Madhulika, Sanujit Pawde, Ajo Sebastian, Swathi Sankar, Sandeep Reddy Chintha
J Trauma Inj. 2023;36(4):369-375.   Published online November 23, 2023
DOI: https://doi.org/10.20408/jti.2023.0042
  • 584 View
  • 20 Download
AbstractAbstract PDF
Purpose
The reconstruction of defects around the knee and the proximal third of the leg necessitates thin, pliable skin with a stable and sensate soft tissue cover. This study analyzed the use of a proximally based sural artery flap for the coverage of such defects.
Methods
This prospective clinical interventional study involved 10 patients who had soft tissue defects over the knee and the proximal third of the leg. These patients underwent reconstruction with a proximally based sural artery flap. The study analyzed various factors including age, sex, etiology, location and presentation of the defect, defect dimensions, flap particulars, postoperative complications, and follow-up.
Results
There were 10 cases, all of which involved men aged 20 to 65 years. The most common cause of injury was trauma resulting from road traffic accidents. The majority of defects were found in the proximal third of the leg, particularly on the anterolateral aspect. Defect dimensions varied from 6×3 to 15×13 cm2, and extensive defects as large as 16×14 cm could be covered using this flap. The size of the flaps ranged from 7×4 to 16×14 cm2, and the pedicle length was 10 to 15 cm. In all cases, donor site closure was achieved with split skin grafting. This flap consistently provided a thin, pliable, stable, and durable soft tissue cover over the defect with no functional deficit and minimal donor site morbidity. Complications, including distal flap necrosis and donor site graft loss, were observed in two cases.
Conclusions
The proximally based sural fasciocutaneous flap serves as the primary method for reconstructing medium to large soft tissue defects around the knee and the proximal third of the leg. This technique offers thin, reliable, sensate, and stable soft tissue coverage, and can cover larger defects with minimal complications.
Summary
Case Report
Thoracoabdominal injury with evisceration from a chainsaw assault: a case report
Babatunde Abayomi Salami, Babatunde Adeteru Ayoade, El-Zaki Abdullahi Shomoye, Chigbundu Collins Nwokoro
J Trauma Inj. 2022;35(2):118-122.   Published online May 11, 2022
DOI: https://doi.org/10.20408/jti.2021.0012
  • 5,486 View
  • 76 Download
AbstractAbstract PDF
The usual cause of penetrating thoracoabdominal injuries with evisceration are stab wounds with knives and other sharp weapons used during fights and conflicts. Evisceration of the abdominal viscera as a result of trauma, with its attendant morbidity and mortality, requires early intervention. Gunshot wounds can also cause penetrating thoracoabdominal injuries. We report the case of a 52-year-old male patient, a worker at a timber-processing factory, who was assaulted with a chainsaw by his colleague following a disagreement. He was seen at the accident and emergency department of our hospital with a thoracoabdominal injury about 1.5 hours after the attack. He had a left thoracoabdominal laceration with abdominal evisceration and an open left pneumothorax. He was managed operatively, made a full recovery, and was discharged 16 days after admission. He was readmitted 4 months after the initial surgery with acute intestinal obstruction secondary to adhesions. He underwent exploratory laparotomy and adhesiolysis. He made an uneventful recovery and was discharged on the ninth postoperative day for subsequent follow-up.
Summary
Original Articles
Traumatic degloving injuries: a prospective study to assess injury patterns, management, and outcomes at a single center in northern India
Divij Jayant, Atul Parashar, Ramesh Sharma
J Trauma Inj. 2023;36(4):385-392.   Published online November 17, 2023
DOI: https://doi.org/10.20408/jti.2023.0032
  • 558 View
  • 28 Download
AbstractAbstract PDF
Purpose
This study investigated the epidemiology, management, outcomes, and postoperative disabilities of degloving soft tissue injuries (DSTIs) treated at a tertiary care center in northern India.
Methods
A prospective study of patients with DSTIs was conducted over 15 months. The type of degloving injury, the mechanism of injury, and any associated injuries were analyzed using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 along with the management, outcomes, and disabilities at a 3-month follow-up.
Results
Among 75 patients with DSTIs, the average age was 27.5 years, 80.0% were male, and 76.0% had been injured in traffic accidents. The majority (93.3%) were open degloving injuries. Lower limbs were affected most often (62.7%), followed by upper limbs (32.0%). Fractures were the most commonly associated injuries (72.0%). Most patients required multiple procedures, including secondary debridement (41.3%), split skin grafting (80.0%), flap coverage (12.0%), or vacuum-assisted closure (24.0%), while five patients underwent conservative management for closed degloving injuries. Postoperative complications included surgical site infections (14.7%) and skin necrosis (10.7%). Two patients died due to septic shock and multiple organ dysfunction syndrome. The mean length of hospital stay was 11.5±8.1 days, with injuries affecting the lower limbs and perineum requiring longer hospital stays. The mean WHODAS 2.0 disability score at 3 months was 19. Most patients had mild disabilities. Time away from work depended largely upon the site and severity of the injury. Approximately 75% of patients resumed their previous job or study, 14% changed their job, and 8% stopped working completely due to residual disability.
Conclusions
Closed degloving injuries may be missed in the primary survey, necessitating a high index of suspicion, thorough clinical examination, and protocol-based management. Primary preventive strategies (e.g., road safety protocols, preplacement training, and proper protective equipment in industries) are also needed to reduce the incidence of these injuries.
Summary
Outcomes and physiologic responses associated with ketamine administration after traumatic brain injury in the United States and Canada: a retrospective analysis
Austin J. Peters, Saad A. Khan, Seiji Koike, Susan Rowell, Martin Schreiber
J Trauma Inj. 2023;36(4):354-361.   Published online November 7, 2023
DOI: https://doi.org/10.20408/jti.2023.0034
  • 682 View
  • 39 Download
AbstractAbstract PDFSupplementary Material
Purpose
Ketamine has historically been contraindicated in traumatic brain injury (TBI) due to concern for raising intracranial pressure. However, it is increasingly being used in TBI due to the favorable respiratory and hemodynamic properties. To date, no studies have evaluated whether ketamine administered in subjects with TBI is associated with patient survival or disability.
Methods
We performed a retrospective analysis of data from the multicenter Prehospital Tranexamic Acid Use for Traumatic Brain Injury trial, comparing ketamine-exposed and ketamine-unexposed TBI subjects to determine whether an association exists between ketamine administration and mortality, as well as secondary outcome measures.
Results
We analyzed 841 eligible subjects from the original study, of which 131 (15.5%) received ketamine. Ketamine-exposed subjects were younger (37.3±16.9 years vs. 42.0±18.6 years, P=0.037), had a worse initial Glasgow Coma Scale score (7±3 vs. 8±4, P=0.003), and were more likely to be intubated than ketamine-unexposed subjects (88.5% vs. 44.2%, P<0.001). Overall, there was no difference in mortality (12.2% vs. 15.5%, P=0.391) or disability measures between groups. Ketamine-exposed subjects had significantly fewer instances of elevated intracranial pressure (ICP) compared to ketamine-unexposed subjects (56.3% vs. 82.3%, P=0.048). In the very rare outcomes of cardiac events and seizure activity, seizure activity was statistically more likely in ketamine-exposed subjects (3.1% vs. 1.0%, P=0.010). In the intracranial hemorrhage subgroup, cardiac events were more likely in ketamine-exposed subjects (2.3% vs. 0.2%, P=0.025). Ketamine exposure was associated with a smaller increase in TBI protein biomarker concentrations.
Conclusions
Ketamine administration was not associated with worse survival or disability despite being administered to more severely injured subjects. Ketamine exposure was associated with reduced elevations of ICP, more instances of seizure activity, and lower concentrations of TBI protein biomarkers.
Summary
Clinical characteristics and mortality risk factors among trauma patients by age groups at a single center in Korea over 7 years: a retrospective study
Jonghee Han, Su Young Yoon, Junepill Seok, Jin Young Lee, Jin Suk Lee, Jin Bong Ye, Younghoon Sul, Seheon Kim, Hong Rye Kim
J Trauma Inj. 2023;36(4):329-336.   Published online November 7, 2023
DOI: https://doi.org/10.20408/jti.2023.0035
  • 567 View
  • 28 Download
AbstractAbstract PDF
Purpose
In this study, we aimed to compare the characteristics of patients with trauma by age group in a single center in Korea to identify the clinical characteristics and analyze the risk factors affecting mortality.
Methods
Patients aged ≥18 years who visited the Chungbuk National University Hospital Regional Trauma Center between January 2016 and December 2022 were included. The accident mechanism, severity of the injury, and outcomes were compared by classifying the patients into group A (18–64 years), group B (65–79 years), and group C (≥80 years). In addition, logistic regression analysis was performed to identify factors affecting death.
Results
The most common injury mechanism was traffic accidents in group A (40.9%) and slipping in group B (37.0%) and group C (56.2%). Although group A had the highest intensive care unit admission rate (38.0%), group C had the highest mortality rate (9.5%). In the regression analysis, 3 to 8 points on the Glasgow Coma Scale had the highest odds ratio for mortality, and red blood cell transfusion within 24 hours, intensive care unit admission, age, and Injury Severity Score were the predictors of death.
Conclusions
For patients with trauma, the mechanism, injured body region, and severity of injury differed among the age groups. The high mortality rate of elderly patients suggests the need for different treatment approaches for trauma patients according to age. Identifying factors affecting clinical patterns and mortality according to age groups can help improve the prognosis of trauma patients in the future.
Summary
Impact of nonphysician, technology-guided alert level selection on rates of appropriate trauma triage in the United States: a before and after study
Megan E. Harrigan, Pamela A. Boremski, Bryan R. Collier, Allison N. Tegge, Jacob R. Gillen
J Trauma Inj. 2023;36(3):231-241.   Published online September 13, 2023
DOI: https://doi.org/10.20408/jti.2023.0020
  • 1,047 View
  • 30 Download
AbstractAbstract PDF
Purpose
The rates of overtriage and undertriage are critical metrics in trauma care, influenced by the criteria for trauma team activation (TTA) and compliance with these criteria. An analysis of undertriaged patients at a level I trauma center revealed suboptimal compliance with existing criteria. This study was conducted to assess triage patterns after the implementation of compliance-focused process interventions.
Methods
Several workflow changes were made to transform a physician-driven, free-text alert system into a nonphysician, hospital dispatcher–guided system. The latter system employs dropdown menus to maximize compliance with existing TTA criteria. The preintervention period included patients who presented to the level I trauma center between May 12, 2020, and December 31, 2020. The postintervention period incorporated patients who presented from May 12, 2021, through December 31, 2021. We evaluated the rates of appropriate triage, overtriage, and undertriage using the Standardized Trauma Assessment Tool and patient characteristics from the trauma registry. All statistical analyses were conducted with an α level of 0.05.
Results
The patient characteristics were largely comparable between the preintervention and postintervention groups. The new system was associated with improved overall compliance with the existing TTA criteria (from 70.3% to 79.3%, P=0.023) and a decreased rate of undertriage (from 6.0% to 3.2%, P=0.002) at the expense of increasing overtriage (from 46.6% to 57.4%, P<0.001), ultimately decreasing the appropriate triage rate (from 78.4% to 74.6%, P=0.007).
Conclusions
This study assessed an easily implementable workflow change designed to improve compliance with TTA criteria. Improved compliance decreased undertriage rates to below the target threshold of 5%, albeit at the expense of increased overtriage. The observed decrease in appropriate triage despite compliance improvements suggests that the current TTA criteria at this institution are not adequately tailored to optimally balance the minimization of both undertriage and overtriage. This finding underscores the importance of improved compliance in evaluating the efficacy of TTA criteria.
Summary
Quality monitoring of resuscitative endovascular balloon occlusion of the aorta using cumulative sum analysis in Korea: a case series
Hyunsik Choi, Joongsuck Kim, Kwanghee Yeo, Ohsang Kwon, Kyounghwan Kim, Wu Seong Kang
J Trauma Inj. 2023;36(2):78-86.   Published online December 21, 2022
DOI: https://doi.org/10.20408/jti.2022.0069
  • 1,658 View
  • 44 Download
  • 1 Citations
AbstractAbstract PDF
Purpose
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a state-of-the-art lifesaving procedure. However, due to its high mortality and morbidity, including ischemia and reperfusion injury, well-trained medical staff and effective systems are needed. This study was conducted to investigate the learning curve for REBOA.
Methods
To monitor this learning curve, we used cumulative sum (CUSUM) analysis and graphs of mortality and aortic occlusion time within 60, 90, and 120 minutes for consecutive patients. The procedures performed between July 2017 and June 2021 were divided into pre-trauma center (pre-TC; July 2017–February 2020) and TC (February 2020–June 2021) periods.
Results
REBOA was performed for 31 consecutive patients with trauma. The pre-TC (n=12) and TC (n=19) periods did not differ significantly with regard to Injury Severity Score, age, injury mechanism, initial systolic blood pressure, prehospital cardiopulmonary resuscitation (CPR), or CPR in the emergency department. At the 17th consecutive patient during the TC period, CUSUM failure graphs for mortality and aortic occlusion time exhibited a downward inflection, indicating an improvement in performance.
Conclusions
The mortality and aortic occlusion time of REBOA improved, and these parameters can be monitored using CUSUM analysis at the hospital level.
Summary

Citations

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  • Nonselective versus Selective Angioembolization for Trauma Patients with Pelvic Injuries Accompanied by Hemorrhage: A Meta-Analysis
    Hyunseok Jang, Soon Tak Jeong, Yun Chul Park, Wu Seong Kang
    Medicina.2023; 59(8): 1492.     CrossRef
Thoracolumbar spine fracture patterns, etiologies, and treatment modalities in Jordan
Ahmad Almigdad, Sattam Alazaydeh, Mohammad Bani Mustafa, Mu'men Alshawish, Anas Al Abdallat
J Trauma Inj. 2023;36(2):98-104.   Published online April 14, 2023
DOI: https://doi.org/10.20408/jti.2022.0068
  • 1,624 View
  • 96 Download
AbstractAbstract PDF
Purpose
Spine fractures are a significant cause of long-term disability and socioeconomic burden. The incidence of spine fractures tends to increase with age, decreased bone density, and fall risk. In this study, we evaluated thoracolumbar fractures at a tertiary hospital in Jordan regarding their frequency, etiology, patterns, and treatment modalities.
Methods
The clinical and radiological records of 469 patients with thoracolumbar fractures admitted to the Royal Medical Services from July 2018 to August 2022 were evaluated regarding patients’ age, sex, mechanism of injury, fracture level and pattern, and treatment modalities.
Results
The mean age of patients was 51.24±20.22 years, and men represented 52.3%. Compression injuries accounted for 97.2% of thoracolumbar fractures, and the thoracolumbar junction was the most common fracture location. Falling from the ground level was the most common mechanism and accounted for half of the injuries. Associated neurological injuries were identified in 3.8% of patients and were more common in younger patients. Pathological fractures were found in 12.4% and were more prevalent among elderly patients and women.
Conclusions
Traffic accidents and falling from height were the most common causes of spine fractures in patients younger than 40. However, 70% of spine fractures in women were caused by simple falls, reflecting the high prevalence of osteoporosis among women and the elderly. Therefore, traffic and work safety measures, as well as home safety measures and osteoporosis treatment for the elderly, should be recommended to reduce the risk of spine fractures.
Summary
Review Article
Endovascular embolization of persistent liver injuries not responding to conservative management: a narrative review
Simon Roh
J Trauma Inj. 2023;36(3):165-171.   Published online September 15, 2023
DOI: https://doi.org/10.20408/jti.2023.0040
  • 1,031 View
  • 58 Download
AbstractAbstract PDF
Trauma remains a significant healthcare burden, causing over five million yearly fatalities. Notably, the liver is a frequently injured solid organ in abdominal trauma, especially in patients under 40 years. It becomes even more critical given that uncontrolled hemorrhage linked to liver trauma can have mortality rates ranging from 10% to 50%. Liver injuries, mainly resulting from blunt trauma such as motor vehicle accidents, are traditionally classified using the American Association for the Surgery of Trauma grading scale. However, recent developments have introduced the World Society of Emergency Surgery classification, which considers the patient's physiological status. The diagnostic approach often involves multiphase computed tomography (CT). Still, newer methods like split-bolus single-pass CT and contrast-enhanced ultrasound (CEUS) aim to reduce radiation exposure. Concerning management, nonoperative strategies have emerged as the gold standard, especially for hemodynamically stable patients. Incorporating angiography with embolization has also been beneficial, with success rates reported between 80% and 97%. However, it is essential to identify the specific source of bleeding for effective embolization. Given the severity of liver trauma and its potential complications, innovations in diagnostic and therapeutic approaches have been pivotal. While CT remains a primary diagnostic tool, methods like CEUS offer safer alternatives. Moreover, nonoperative management, especially when combined with angiography and embolization, has demonstrated notable success. Still, the healthcare community must remain vigilant to complications and continuously seek improvements in trauma care.
Summary
Case Report
Submental intubation using laparoscopic trocar in zygomaticomaxillary complex fracture surgery in Korea: a case report
Hyejin Do, Chunui Lee, Hyeon Don Hong, Hyejin Hong, Hyun Kyo Lim, Sujin Kim
J Trauma Inj. 2023;36(2):128-132.   Published online December 21, 2022
DOI: https://doi.org/10.20408/jti.2022.0036
  • 1,600 View
  • 48 Download
AbstractAbstract PDF
Submental intubation is an effective alternative technique for airway management in patients with maxillofacial trauma. Compared with tracheostomy, it is less invasive, but has risks associated with potential airway compromise such as hypoxia due to tube obstruction, collapse, and kinking. To shorten procedure time and ensure a reinforced tube lumen, we used a laparoscopic trocar as a new device for submental intubation. A 54-year-old male patient sustained a zygomaticomaxillary complex fracture and was scheduled to undergo open reduction and internal fixation. We performed intraoral intubation and made a small 1-cm incision at the submandibular midline. After dissection of the tissue from the incision site, a reinforced tube was passed using a 12-mm laparoscopic trocar. The procedure took about 5 minutes, and apnea time from disconnecting the breathing circuit and passing through the internal lumen of the trocar until it was reconnected to the ventilator was 1 minute 5 seconds. Using a laparoscopic trocar for submental intubation can reduce the time required for dissection, prevent luminal occlusion complications due to soft tissues or blood clots in the endotracheal tube, and decrease soft tissue damage.
Summary
Original Article
National utilization of rib fracture fixation in the geriatric population in the United States
Jennifer M. Brewer, Leah Aakjar, Kelsey Sullivan, Vijay Jayaraman, Manuel Moutinho, Elan Jeremitsky, Andrew R. Doben
J Trauma Inj. 2022;35(3):173-180.   Published online May 31, 2022
DOI: https://doi.org/10.20408/jti.2021.0076
  • 2,007 View
  • 52 Download
AbstractAbstract PDF
Purpose
The use of surgical stabilization of rib fractures (SSRF) has steadily increased over the past decade. Recent literature suggests that a larger population may benefit from SSRF, and that the geriatric population—as the highest-risk population—may receive the greatest improvement from these interventions. We sought to determine the overall utilization of SSRF in the United States.
Methods
The National Trauma Database was analyzed between 2016 and 2017. The inclusion criteria were all patients ≥65 years old with rib fractures. We further stratified these patients according to age (65–79 vs. ≥80 years old), the presence of coding for flail chest, three or more rib fractures, and intervention (surgical vs. nonoperative management). The main outcomes were surgical interventions, mortality, pneumonia, length of stay, intensive care unit length of stay, ventilator use, and tracheostomy.
Results
Overall, 93,638 patients were identified. SSRF was performed in 992 patients. Patients who underwent SSRF had improved mortality in the 65 to 79 age group, regardless of the number of ribs fractured. We identified 92,637 patients in the age group of 65 to 79 years old who did not undergo SSRF. This represents an additional 20,000 patients annually who may benefit from SSRF.
Conclusions
By conservative standards and the well-established Eastern Association for the Surgery of Trauma clinical practice guidelines, SSRF is underutilized. Our data suggest that SSRF may be very beneficial for the geriatric population, specifically those aged 65 to 79 years with any rib fractures. We hypothesize that roughly 20,000 additional cases will meet the inclusion criteria for SSRF each year. It is therefore imperative that we train acute care surgeons in this skill set.
Summary

J Trauma Inj : Journal of Trauma and Injury