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6 "Conservative treatment"
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Case Reports
Conservative treatment of corpus callosum hemorrhage due to a falling coconut in Indonesia: a case report
Hanan Anwar Rusidi, Ferry Wijanarko
J Trauma Inj. 2024;37(1):79-82.   Published online January 12, 2024
DOI: https://doi.org/10.20408/jti.2023.0052
  • 573 View
  • 16 Download
AbstractAbstract PDF
The potential for traumatic brain injury resulting from falling coconuts is frequently overlooked. These incidents can cause focal lesions in the form of brain hemorrhage. Corpus callosum hemorrhage due to blunt trauma from a falling object is rare and typically associated with poor prognosis. The purpose of this report is to detail a case of corpus callosum hemorrhage caused by a coconut fall and to discuss the conservative management approach employed. We report the case of a 54-year-old woman who was admitted to the hospital with symptoms of unconsciousness, headache, and expressive aphasia after being struck by a falling coconut. Notably, hemorrhage was detected within the body of the corpus callosum, as revealed by imaging findings. The patient received intensive monitoring and treatment in the intensive care unit, including oxygen therapy, saline infusion, an osmotic diuretic, analgesics, and medication to prevent stress ulcers. The patient demonstrated marked clinical improvement while undergoing conservative treatment. Despite the typically unfavorable prognosis of these rare injuries, our patient exhibited meaningful clinical improvement with conservative treatment. Timely diagnosis and appropriate interventions were crucial in managing the patient’s condition. This report emphasizes the importance of considering traumatic brain injury caused by falling coconuts and highlights the need for further research and awareness in this area.
Summary
Nonoperative management of colon and mesocolon injuries caused by blunt trauma: three case reports
Naa Lee, Euisung Jeong, Hyunseok Jang, Yunchul Park, Younggoun Jo, Jungchul Kim
J Trauma Inj. 2022;35(4):291-296.   Published online September 19, 2022
DOI: https://doi.org/10.20408/jti.2022.0009
  • 1,884 View
  • 39 Download
AbstractAbstract PDF
The therapeutic approach for colon injury has changed continuously with the evolution of management strategies for trauma patients. In general, immediate laparotomy can be considered in hemodynamically unstable patients with positive findings on extended focused assessment with sonography for trauma. However, in the case of hemodynamically stable patients, an additional evaluation like computed tomography (CT) is required. Surgical treatment is often required if prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation are observed. However, immediate intervention in hemodynamically stable patients without indications for surgical treatment remains questionable. Three patients with colon and mesocolon injuries caused by blunt trauma were treated by nonoperative management. At the time of admission, they were alert and their vital signs were stable. Colon and mesocolon injuries, large hematoma, colon wall edema, and/or ischemia were revealed on CT. However, no prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation were observed. In two cases, conservative treatment was performed without worsening abdominal pain or laboratory tests. Follow-up CT showed improvement without additional treatment. In the third case, follow-up CT and percutaneous drainage were performed in considering the persistent left abdominal discomfort, fever, and elevated inflammatory markers of the patient. After that, outpatient CT showed improvement of the hematoma. In conclusion, nonoperative management can be considered as a therapeutic option for mesocolon and colon injuries caused by blunt trauma of selected cases, despite the presence of large hematoma and ischemia, if there are no clear indications for immediate intervention.
Summary
Original Articles
Adult Trauma Patients with Isolated Thoracolumbar Spinous and Transverse Process Fractures May be Managed Conservatively to Improve Emergency Department Throughput
Kyrillos Awad, Dean Spencer, Divya Ramakrishnan, Marija Pejinovska, Areg Grigorian, Sebastian Schubl, Jeffry Nahmias
J Trauma Inj. 2021;34(1):31-38.   Published online February 24, 2021
DOI: https://doi.org/10.20408/jti.2020.006
  • 3,385 View
  • 124 Download
AbstractAbstract PDF
Purpose

Traumatic vertebral injuries have a prevalence of 4–5% at level I centers. Studies have demonstrated that isolated thoracolumbar transverse process fractures (iTPF) rarely require brace or surgical interventions. We hypothesized that similarly isolated thoracolumbar spinous process fractures (iSPF) would have less need for bracing and operative interventions than SPFs with associated vertebral body (VB) fractures (SPF+VB). We performed a similar analysis for iTPF compared to transverse process fractures associated with VB injury (TPF+VB).

Methods

In this single-center, retrospective study from 2012 to 2016, patients were classified into iSPF, SPF+VB, iTPF, and TPF+VB groups. Data including the fracture pattern, neurologic deficits, and operative intervention were obtained. The primary outcome studied was the need for bracing and/or surgery. A statistical analysis was conducted.

Results

Of 98 patients with spinous process fractures, 21 had iSPF and 77 had SPF+ VB. No iSPF patients underwent surgery, whereas 24 (31.17%) SPF+VB patients did undergo surgery (p=0.012). In the iSPF group, three patients (15%) received braces only for comfort, whereas 37 (48.68%) of the SPF+VB group required bracing (p=0.058). Of 474 patients with transverse process fractures, 335 had iTPF and 139 had TPF+VB. No iTPF patients underwent surgery, whereas 28 (20.14%) TPF+VB patients did (p≤ 0.001). Of the iTPF patients, six (1.86%) were recommended to receive braces only for comfort, while 68 (50.75%) of the TPF+VB patients required bracing (p<0.001).

Conclusions

No patients with iSPF or iTPF required surgical intervention, and bracing was recommended to patients in these groups for comfort only. It appears that these injures may be safely managed without interventions, calling into question the need for spine consultation.

Summary
Management of High-grade Blunt Renal Trauma
Min A Lee, Myung Jin Jang, Gil Jae Lee
J Trauma Inj. 2017;30(4):192-196.   Published online December 30, 2017
DOI: https://doi.org/10.20408/jti.2017.30.4.192
  • 4,211 View
  • 162 Download
  • 5 Citations
AbstractAbstract PDF
Purpose

Blunt injury accounts for 80?95% of renal injury trauma in the United States. The majority of blunt renal injuries are low grade and 80?85% of these injuries can be managed conservatively. However, there is a debate on the management of patients with high-grade renal injury. We reviewed our experience of renal trauma at our trauma center to assess management strategy for high-grade blunt renal injury.

Methods

We reviewed blunt renal injury cases admitted at a single trauma center between August 2007 and December 2015. Computed tomography (CT) scan was used to diagnose renal injuries and high?grade (according to the American Association for the Surgery of Trauma [AAST] organ injury scale III?V) renal injury patients were included in the analysis.

Results

During the eight?year study period, there were 62 AAST grade III?V patients. 5 cases underwent nephrectomy and 57 underwent non-operative management (NOM). There was no difference in outcome between the operative group and the NOM group. In the NOM group, 24 cases underwent angioembolization with a 91% success rate. The Incidence of urological complications correlated with increasing grade.

Conclusions

Conservative management of high-grade blunt renal injury was considered preferable to operative management, with an increased renal salvage rate. However, high-grade injuries have higher complication rates, and therefore, close observation is recommended after conservative management.

Summary

Citations

Citations to this article as recorded by  
  • Functional range of the kidney after a low-severity injury: a randomized study
    K. A. Chiglintsev, A. V. Zyryаnov, A. Yu. Chiglintsev, A. A. Makarian
    Diagnostic radiology and radiotherapy.2023; 14(2): 74.     CrossRef
  • Outcome of Kidney Trauma Management: Experiences from a Tertiary Referral Hospital in East Indonesia
    Yufi Aulia Azmi, Danang Irsayanto, Kevin Muliawan Soetanto, Johan Renaldo, Soetojo Wirjopranoto
    Biomolecular and Health Science Journal.2023; 6(2): 135.     CrossRef
  • RENAL TRAUMA: PROFILE AND MANAGEMENT
    Vipul Bakshi, Tariq A Mir, Harmandeep Singh Chahal
    GLOBAL JOURNAL FOR RESEARCH ANALYSIS.2022; : 109.     CrossRef
  • Management of renal injury in a UK major trauma centre
    Robert Torrance, Abigail Kwok, David Mathews, Matthew Elliot, Andrew Baird, Marc A Lucky
    Trauma.2020; 22(1): 26.     CrossRef
  • Renal trauma: a 5-year retrospective review in single institution
    Syarif, Achmad M. Palinrungi, Khoirul Kholis, Muhammad Asykar Palinrungi, Syakri Syahrir, Reinaldo Sunggiardi, Muhammad Faruk
    African Journal of Urology.2020;[Epub]     CrossRef
Case Reports
Pulmonary Bone Cement Embolism Following Percutaneous Vertebroplasty
Yong Han Cha
J Trauma Inj. 2015;28(3):202-205.   Published online September 30, 2015
DOI: https://doi.org/10.20408/jti.2015.28.3.202
  • 1,882 View
  • 6 Download
  • 1 Citations
AbstractAbstract PDF
PURPOSE
Pulmonary cement embolization after vertebroplasty is a well-known complication. The reported incidence of pulmonary cement emboli after vertebroplasty ranges frome 2.1% to 26% with much of this variation resulting from which radiographic technique is used to detect embolization. Onset and severity of symptoms are variable.
CASE
DESCRIPTION: We present the case of a 83-year-old women who underwent fourth lumbar vertebroplasty and subsequently had dyspnea several days later. Posteroanterior chest radiography showed multiple linear densities. Computed tomography of thorax revealed also multiple bilateral, linear hyperdensities within the lobar pulmonary artery branches are detected in axial and coronal views. LITERATURE REVIEWS: Operative management of vertebral compression fractures has included percutaneous vetebroplasty for the past 25 years. Symptoms of pulmonary cement embolism can occur during procedure, but more commonly begin days to weeks, even months, after vertebroplsty. Most cases of pulmonary cement emboli with cardiovascular and pulmonary complications are treated nonoperatively with anticoagulation. Endovascular removal of large cement emboli from the pulmonary arteries is not without risk and sometimes requires open surgery for complete removal of cement pieces.
CONCLUSION
Pulmonary cement embolism is a potentially serious complication of vertebroplasty. If a patient has chest pain or respiratory difficulty after the procedure, chest radiography and possibly advanced chest imaging studies should be performed immediately.
Summary

Citations

Citations to this article as recorded by  
  • Micro- and Nanoparticulate Hydroxyapatite Powders as Fillers in Polyacrylate Bone Cement—A Comparative Study
    Anna Sobczyk-Guzenda, Paulina Boniecka, Anna Laska-Lesniewicz, Marcin Makowka, Hieronim Szymanowski
    Materials.2020; 13(12): 2736.     CrossRef
A Hip 14 Years after a Non-surgiclly-treated Pipkin Type-II Fracture of the Femoral Head: A Case Report
Young Kyun Lee, Yong Chan Ha, Kyung Hoi Koo
J Korean Soc Traumatol. 2012;25(1):25-27.
  • 1,013 View
  • 2 Download
AbstractAbstract PDF
A 30-year-old, male truck driver had a traffic accident and visited a hospital due to left hip pain. The patient's femoral head was fractured, and he was treated conservatively. For 14 years afterwards, he walked without a limp, had no pain, and drove his truck. He was involved in another traffic accident and experienced a comminuted fracture of the left distal femur 14 years after the initial injury. Although he was symptom-free, while being treated by open reduction and internal fixation for the distal femur fracture, he was concerned about the status of his left femoral head. Pelvis radiographs and reconstructed CT images were done, and they showed a spur change around the femoral head which had a dense sclerotic band within and revealed a slight depression of subchondral bone of the medial portion of the femoral head. The diagnosis was a Pipkin type-II fracture of the femoral head.
Summary

J Trauma Inj : Journal of Trauma and Injury