Journal of Trauma and Injury

Original Article

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

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Abstract 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

Case Reports

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

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Abstract 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

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

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Abstract 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

Review Article

Iatrogenic Ureteral Injury: When and How to Treat?: Kang Il Seo, Jong Bouk Lee; J Korean Soc Traumatol. 2008;21(1):8-14.

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Abstract PDF: Iatrogenic ureteral injury is a complication that can occur during a variety of pelvic or abdominal surgeries. The most frequent causes are gynecological ones, followed by colon and vascular surgeries. Management of ureteric injury depends on the time of diagnosis and the severity of organ damage. Injuries diagnosed intraoperatively should be treated immediately. Occasionally, intraoperative ureteral injury is overlooked, and symptoms of the late diagnosis of ureteral injury are usually nonspecific; therefore, the diagnosis is delayed for days or weeks postoperatively. Management of injuries diagnosed postoperatively is more complex. There are differing opinions on whether an initial conservative or immediate operative intervention is the best line of action. Delayed repair is suggested on the grounds that it will reduce inflammation and tissue edema. However, many authors are in favor of early repair, perhaps because tissue planes are easier to find before fibrosis becomes too dense. Ureteral injuries occurring at the level of the pelvic brim should be best managed with an end-to-end anastomosis, preferably around a ureteric stent. More distal injuries also should be ideally managed with an end-to-end anastomosis, after excision of the crushed or compromised segments. However, if the remaining distal segment is short, ureteral reimplantation is the procedure of choice. The Boari flap technique for ureteral reimplantation is invaluable in cases with a short proximal segment. Delayed recognition of iatrogenic ureteral injury may be associated with serious complications, so prompt recognition of ureteral injuries is important. Recognition of the injury before closure is the key to easy, successful, and complications-free repair. Increased awareness of the risk for ureteral damage during certain operative maneuvers is vital to prevent injury, and to decrease the incidence of iatrogenic injury. A sound knowledge of abdominal and pelvic anatomy is the best prevention.; Summary

Original Article

Clinical Outcomes of Splenic Injury: Seung Hyun Baek, Sung Jin Park, Jae Hoon Kim, Hyun Seong Kim, Dae Hwan Kim, Hong Jae Jo, Hyung Il Seo; J Korean Soc Traumatol. 2012;25(2):44-48.

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Abstract PDF: PURPOSE
The management of splenic injuries has shifted from a splenectomy to splenic preservation owing to immunity. The purpose of this study was to assess the kinds of management and outcomes through a review of our experience with splenic injuries.
METHODS
We retrospectively reviewed 47 patients with traumatic splenic injuries using by electronic medical records from Jan. 2007 and Dec. 2011. Splenic injuries were classified according to the American Association for the Surgery of Trauma (AAST) grading system.
RESULTS
There were 11 falls, 11 traffic accidents, 10 motorcylcle accidents, 10 pedestrian accidents and 5 abdominal blunt traumas. Low-grade injured patients (< or =Grade III) were 29 of 43(61.7%), and High-grade injured patients (> or =Grade IV) were 18 of 43(38.3%). In 34 patients, non-surgical treatment was performed, and 14 patients underwent a splenectomy. There were relatively more high-grade in older patients, and the highgrade-injury group showed need for a transfusion (p=0.002), more need for a splenectomy (p<0.001), a longer mean hospital stay (p=0.036), a longer ICU stay (p=0.045) and more combined organ injury (p=0.036).
CONCLUSION
Conservative treatment should be considered in low-grade-injury patients (< or =Grade III). A Splenectomy was performed on 56% of the patients with Grade IV injuries, so a splenectomy should be considered carefully in such patients. In patients with a grade V injury, we think surgical treatment may be needed.; Summary

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