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Case Reports
Preperitoneal pelvic packing as a salvage operation for postoperative retroperitoneal bleeding with hemodynamic instability after the Kocher-Langenbeck approach to the acetabulum: a case report
Doo-Hun Kim, Maru Kim, Dae-Sang Lee, Tae Hwa Hong, Hangjoo Cho
J Trauma Inj. 2025;38(3):285-289.   Published online June 25, 2025
DOI: https://doi.org/10.20408/jti.2024.0087
  • 4,275 View
  • 59 Download
AbstractAbstract PDF
Pelvic fractures result from high-energy trauma, and when accompanied by hemorrhagic shock, the mortality rate increases to 40%. Pelvic fractures are anatomically categorized as pelvic ring disruptions and acetabular fractures, each requiring different treatment methods and approaches. Acetabular fractures, which also result from high-energy injuries, may be accompanied by hemorrhagic shock. Treatment options for pelvic fractures with hemorrhagic shock include angioembolization, preperitoneal pelvic packing (PPP), and emergency laparotomy. In hemodynamically stable patients, early total care may be attempted, and for acetabular fractures (posterior column), the Kocher-Langenbeck approach is the treatment of choice. This case report describes the use of PPP as a salvage operation for postoperative retroperitoneal bleeding with hemodynamic instability following a Kocher-Langenbeck approach for an acetabular fracture with pelvic ring injury. The patient was discharged without postoperative complications such as bone displacement or surgical site infection. While PPP is commonly employed as an initial treatment modality for pelvic fractures with hemorrhagic shock, it may also be valuable in managing postoperative retroperitoneal bleeding with hemorrhagic shock.
Summary
Bleeding control of an injury to the infrarenal inferior vena cava and right external iliac vein by ipsilateral internal iliac artery and superficial femoral vein ligation after blunt abdominal trauma in Korea: a case report
Hoonsung Park, Maru Kim, Dae Sang Lee, Tae Hwa Hong, Doo-Hun Kim, Hang joo Cho
J Trauma Inj. 2023;36(4):441-446.   Published online November 17, 2023
DOI: https://doi.org/10.20408/jti.2023.0019
  • 5,138 View
  • 52 Download
AbstractAbstract PDF
Inferior vena cava (IVC) injuries, while accounting for fewer than 0.5% of blunt abdominal trauma cases, are among the most difficult to manage. Despite advancements in prehospital care, transportation, operative techniques, and perioperative management, the mortality rate for IVC injuries has remained at 20% to 66% for several decades. Furthermore, 30% to 50% of patients with IVC injuries succumb during the prehospital phase. A 65-year-old male patient, who had been struck in the back by a 500-kg excavator shovel at a construction site, was transported to a regional trauma center. Injuries to the right side of the infrarenal IVC and the right external iliac vein (EIV) were suspected, along with fractures to the right iliac bone and sacrum. The injury to the right side of the infrarenal IVC wall was repaired, and the right internal iliac artery was ligated. However, persistent bleeding around the right EIV was observed, and we were unable to achieve proximal and distal control of the right EIV. Attempts at prolonged manual compression were unsuccessful. To decrease venous return, we ligated the right superficial femoral vein. This reduced the amount of bleeding, enabling us to secure the surgical field. We ultimately controlled the bleeding, and approximately 5 L of blood products were infused intraoperatively. A second-look operation was performed 2 days later, by which time most of the bleeding sites had ceased. Orthopedic surgeons then took over the operation, performing closed reduction and external fixation. Five days later, the patient underwent definitive fixation and was transferred for rehabilitation on postoperative day 22.
Summary
Original Articles
Relation between Blood Alcohol Concentration and Clinical Parameters in Trauma Patients
Tae Hwa Hong, Ji Young Jang, Seung Hwan Lee, Hyung Won Kim, Hong Jin Shim, Jae Gil Lee
J Trauma Inj. 2015;28(4):256-261.   Published online December 31, 2015
DOI: https://doi.org/10.20408/jti.2015.28.4.256
  • 4,052 View
  • 22 Download
AbstractAbstract PDF
PURPOSE
The aim of this study was to evaluate the effects of blood alcohol concentration (BAC) on the clinical parameters in trauma patients.
METHODS
From January 2011 to March 2013, the records of a total of 102 trauma patients with BAC data were analyzed retrospectively. The revised trauma score (RTS), injury severity score (ISS), presence of shock, use of mechanical ventilation and blood transfusion, length of hospital stay, and mortality were collected. Patients were divided into four groups in accordance with the level of BAC: group A (<100 mg/dL), B (100~200 mg/dL), C (200~250 mg/dL), and D (>250 mg/dL). Patients were also divided into two groups depending on the presence of the shock, and gender, ISS, BAC, and presence of active bleeding were compared between these two groups.
RESULTS
No statistically significant differences in the ISS, RTS, presence of active bleeding, use of mechanical ventilation, and mortality were noted between groups A to D. However, the presence of shock was significantly higher in group D. After patients with severe chest injuries had been excluded, mechanical ventilation was found to have been applied more frequently in the higher BAC groups (C and D). A logistic regression analysis of these factors showed that extremely high BAC (>250 mg/dL) was an independent indicator of shock.
CONCLUSION
High BAC is a predicator of shock and the need for mechanical ventilation in patients with trauma, regardless of injury severity. Alcohol intoxication leads to an overestimate of the clinical condition and aggressive management for trauma patients. Thus, a guideline for the diagnosis and treatment of patients intoxicated with alcohol is necessary.
Summary
The Influence of How the Trauma Care System Is Applied at the Trauma Center: The Initial Experience at Single Trauma Center
Hyung Won Kim, Tae Hwa Hong, Seung Hwan Lee, Myung Jae Jung, Jae Gil Lee
J Trauma Inj. 2015;28(4):241-247.   Published online December 31, 2015
DOI: https://doi.org/10.20408/jti.2015.28.4.241
  • 3,539 View
  • 15 Download
  • 3 Citations
AbstractAbstract PDF
PURPOSE
To evaluate the influence of how the trauma care system is applied on the management of trauma patients.
METHODS
We divided the patients into a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in our institution. We compared the general characteristics, injury severity score, initial response time to the trauma patients, number of preventable deaths, and clinical outcomes between the two groups.
RESULTS
The numbers of patients in the pre-trauma system group and the post-trauma system group were 188 and 257, respectively. No differences in the patient's median ages, trauma scores (ISS, RTS, TRISS) and proportions of severe trauma patients (ISS>15) were observed between the two groups. The number and the proportion of patients who were admitted to our hospital were increased in the post-trauma system group. The time interval from trauma CP activation to emergency surgery or angio-embolization, and the patient's time spent in emergency room were shortened in the posttrauma system group. However, the lengths of the ICU stay and the hospital stay, and the number of in-hospital mortalities were not improved in the post-trauma system group. In severe trauma patients (ISS>15), there were no differences between the two groups in the number and the proportion of admitted patients, and the time interval from trauma CP activation to performing a diagnostic and therapeutic procedure was not shortened in the post-trauma system group.
CONCLUSION
Application of the trauma care system has shortened the time between the initial response and patient management. However, this improvement was not enough to result in better clinical outcomes. More trauma physicians, multidisciplinary cooperation, and a well-organized trauma management process will be needed if the maximum efficacy of the trauma system is to be achieved.
Summary

Citations

Citations to this article as recorded by  
  • Effectiveness after Designation of a Trauma Center: Experience with Operating a Trauma Team at a Private Hospital
    Kyoung Hwan Kim, Sung Ho Han, Soon-Ho Chon, Joongsuck Kim, Oh Sang Kwon, Min Koo Lee, Hohyoung Lee
    Journal of Trauma and Injury.2019; 32(1): 1.     CrossRef
  • Characteristics and Outcomes of Trauma Patients via Emergency Medical Services
    Dae Hyun Cho, Jae Gil Lee
    Journal of Trauma and Injury.2017; 30(4): 120.     CrossRef
  • Analysis of Abdominal Trauma Patients Using National Emergency Department Information System
    In-Gyu Song, Jin Suk Lee, Sung Won Jung, Jong-Min Park, Han Deok Yoon, Jung Tak Rhee, Sun Worl Kim, Borami Lim, So Ra Kim, Il-Young Jung
    Journal of Trauma and Injury.2016; 29(4): 116.     CrossRef
J Trauma Inj : Journal of Trauma and Injury
© The Korean Society of Traumatology.
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