Journal of Trauma and Injury

Heterodigital flap as a solution for a thumb defect: a case report: Bontor Daniel Sinaga, Dwi Purnomo Setyo Budi, Mochamad Sadabaskara; Received July 19, 2024 Accepted October 1, 2024 Published online November 18, 2024; DOI: https://doi.org/10.20408/jti.2024.0049 [Epub ahead of print]

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Abstract PDF: Thumb traumatic injuries are incredibly common in hand injuries. The thumb is essential to hand function in order to do daily tasks like gripping, holding, opposing, circumducting, and movements. As a result, compared to injuries to other fingers, a thumb injury significantly impairs hand function. Traumas can cause soft tissue loss linked to vascular injuries that require revascularization. Replantation is the surgical treatment most frequently suggested to patients who have had their thumbs amputated in an attempt to restore function and attractiveness. There are alternative reconstructive techniques, such as skin grafting or local, distal, and free flaps, when replantation of the severed segment is not feasible. Reconstruction techniques vary depending on where the amputation occurred and include transfer site reconstruction and homodigital and heterodigital flaps. We reported a case of a woman who has a right traumatic thumb injury due to blender accident. Primary suturing and debridement were done to save the thumb. But after several days, the thumb was necrotic and not viable. Heterodigital island flap from the right middle finger was chosen. Radial forearm skin was grafted to cover the middle finger defect. This gave satisfactory results. Wound healing was quite good, but there were signs of scar tissue growth after several months of follow-up. The function and mobility of the thumb and hand were also achieved well through the QuickDASH (quick Disability of the Arm, Shoulder and Hand) score. Heterodigital flap provides satisfactory results both aesthetically and functionally in traumatic thumb injury cases.; Summary

Differentiation of antimicrobial toxicity and sepsis-induced disseminated intravascular coagulation in an orthopedic burn patient in India: a case report: Parampreet Singh Saini, Ankita Aggarwal, Tarunpreet Saini; Received June 27, 2024 Accepted September 19, 2024 Published online November 18, 2024; DOI: https://doi.org/10.20408/jti.2024.0040 [Epub ahead of print]

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Abstract PDF: Drug-induced thrombocytopenia, hemolytic anemia, and leukopenia are serious, and sometimes fatal, complications of common medications. These conditions are challenging to diagnose in patients with polytrauma injuries due to the presence of multiple potential etiologies. In such clinical scenarios, sepsis-induced disseminated intravascular coagulation is a more frequent diagnosis. The clinical manifestations of these conditions can be indistinguishable. We present the case of a 32-year-old man who sustained a left open grade 2 leg fracture and 18% to 20% second-degree superficial electrical flash burns on his right leg. Following primary management, skin testing for antibiotic sensitivity was performed, and prophylactic therapy with ceftriaxone, gentamycin, and metronidazole was initiated for the grossly contaminated wounds. On the second day of emergency admission, the patient developed hepatorenal dysfunction accompanied by severe thrombocytopenia (<30×103/mm3). The suspected antimicrobial agents were discontinued by the third day. Within 48 hours, the patient’s hepatorenal function markedly improved; however, the blood dyscrasia progressed to severe pancytopenia over the next few days. Despite worsening parameters, the patient’s vitals were maintained, and he exhibited no overt bleeding. On the fourth day, the patient developed opportunistic fungal bronchopneumonia, indicated by bilateral lower lobe infiltrates on chest x-ray and an elevated serum galactomannan level. He received supportive care, broad-spectrum antibiotics, and antifungal treatment, with a full recovery within 2 weeks. Antibiotic toxicity must be distinguished from other medical conditions to ensure appropriate management and a favorable prognosis.; Summary

Purtscher retinopathy following isolated chest compression: a case report: Min Uk Jang, Ho Gil Jung, Youngwoong Kim; Received May 24, 2024 Accepted September 10, 2024 Published online October 21, 2024; DOI: https://doi.org/10.20408/jti.2024.0032 [Epub ahead of print]

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Abstract PDF: This case report describes the case of a 56-year-old man who developed Purtscher retinopathy following compressive chest trauma. During the tertiary survey, the patient was found to have a unilateral partial vision decline despite sustaining only mild rib fractures. The patient was diagnosed with a rare complication of Purtscher retinopathy. At a 2-week follow-up outpatient examination, improved visual acuity was observed. This case highlights the importance of conducting a tertiary survey not only on the directly impacted site, but also comprehensively across all sites, while attentively listening to and addressing the patient’s complaints.; Summary

A starry night: a case report of severe liver injury due to a close-range shotgun blast in Argentina: Rodrigo Antonio Gasque, José Gabriel Cervantes, Magalí Chahdi Beltrame, Marcelo Enrique Lenz-Virreira, Emilio Gastón Quiñonez; Received June 16, 2024 Accepted August 29, 2024 Published online October 21, 2024; DOI: https://doi.org/10.20408/jti.2024.0036 [Epub ahead of print]

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Abstract PDF: This report presents the case of a 20-year-old man who sustained a severe liver injury from a closerange shotgun blast. A prompt medical intervention, including damage control exploratory laparotomy and surgical debridement, was undertaken due to the extent of liver damage. Despite challenges such as a nondirected biliary fistula and extensive liver parenchymal injury, comprehensive surgical management led to successful treatment. Postoperative complications, including biloma and fungal infection, were managed appropriately, highlighting the importance of vigilant follow-up care. The case underscores the complexity of managing severe liver trauma and emphasizes the evolving role of trauma damage control strategies and minimally invasive procedures in achieving favorable outcomes.; Summary

Acute irreducible anterior shoulder dislocation due to interposition of the subscapularis muscle and the lesser tuberosity: a case report: Nazim Sifi, Ahmad Madani, Mahdi Zeghdoud; Received July 7, 2024 Accepted August 29, 2024 Published online October 21, 2024; DOI: https://doi.org/10.20408/jti.2024.0044 [Epub ahead of print]

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Abstract PDF: Efforts to reduce an anterior shoulder dislocation can fail due to numerous mechanical obstructions caused by soft tissue interposition (long head of the biceps, rotator cuff muscles, labrum, musculocutaneous nerve) and/or bony elements (displaced fragment of a greater tuberosity or glenoid fracture, bone impaction such as a Hill-Sachs lesion fixed on the glenoid rim, a bony Bankart lesion). Herein, we report the case of a 35-year-old man who sustained an anterior shoulder fracture-dislocation of his left shoulder after a fall. Despite a postreduction radiological examination that appeared misleadingly reassuring, subtle signs of persistent subluxation raised concerns. A computed tomography (CT) scan revealed subscapularis muscle entrapment along with avulsion of its bony insertion from the lesser tuberosity of the humerus, and a comminuted avulsion fracture of the greater tuberosity of the humerus. The patient underwent surgery using a deltopectoral approach. This involved releasing the entrapped subscapularis muscle and fixing the two fractured fragments. The lesser tuberosity was reduced and secured with two cannulated screws, and the comminuted fragment of the greater tuberosity was reattached using transosseous sutures. At 12-month follow-up, the patient achieved a Constant-Murley score of 85 of 100, with limitation in internal rotation at L3 but no signs of instability or new dislocation episode. This case underscores the importance of confirming shoulder reduction on at least two orthogonal views and paying close attention to the patient’s feedback about sensation in their shoulder. Additionally, it highlights the utility of CT or magnetic resonance imaging scans if doubt exists about the integrity of the reduction.; Summary

Endoscopic transorbital approach for the removal of a frontal lobe foreign body: a case report: Charles Gervais, Conrad Pelletier, Mathieu Laroche, Pascal Lavergne; Received January 17, 2024 Accepted August 29, 2024 Published online September 25, 2024; DOI: https://doi.org/10.20408/jti.2024.0002 [Epub ahead of print]

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Abstract PDF: Low-velocity orbital penetrating injuries may result in an intracranial retained foreign body that requires surgical removal. We describe the endoscopic transorbital removal of a retained umbrella tip in the frontal lobe, which was secondary to trauma to the orbital roof. This technique facilitated the complete removal of the foreign body without causing additional damage to the surrounding tissue. The patient had a successful postoperative recovery. We also discuss the utility of the transorbital neuroendoscopic procedure in managing these traumatic injuries.; Summary

Where the land ends and the sea begins: Kun Hwang; Received December 10, 2022 Accepted January 26, 2023 Published online June 9, 2023; DOI: https://doi.org/10.20408/jti.2022.0081 [Epub ahead of print]

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Development of variolation and its introduction to Joseon-era Korea: Kun Hwang; Received August 19, 2022 Accepted August 29, 2022 Published online October 26, 2022; DOI: https://doi.org/10.20408/jti.2022.0044 [Epub ahead of print]

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