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Case Report
Atypical Vancouver B1 periprosthetic fracture of the proximal femur in the United Kingdom: a case report challenged by myeloma, osteoporosis, infection, and recurrent implant failures
Sayantan Saha, Azeem Ahmed, Rama Mohan
J Trauma Inj. 2024;37(1):89-96.   Published online March 18, 2024
DOI: https://doi.org/10.20408/jti.2023.0069
  • 435 View
  • 21 Download
AbstractAbstract PDF
The indications for total hip replacement are increasing and not limited to osteoarthritis. Total hip replacement may also be done for trauma and pathological fractures in patients otherwise physiologically fit and active. This trend has led to an inevitable rise in complications such as periprosthetic femoral fracture. Periprosthetic femoral fracture can be challenging due to poor bone quality, osteoporosis, and stress fractures. We present a case of periprosthetic femoral fracture in a 71-year-old woman with some components of an atypical femoral fracture. The fracture was internally fixed but was subsequently complicated by infection, implant failure needing revision, and later stress fracture. She was on a bisphosphonate after her index total hip replacement surgery for an impending pathological left proximal femur fracture, and this may have caused the later stress fracture. Unfortunately, she then experienced implant breakage (nonunion), which was treated with a biplanar locking plate and bone grafting. The patient finally regained her premorbid mobility 13 months after the last surgery and progressed satisfactorily towards bony union.
Summary
Original Articles
Postoperative infection after cranioplasty in traumatic brain injury: a single center experience
Mahnjeong Ha, Jung Hwan Lee, Hyuk Jin Choi, Byung Chul Kim, Seunghan Yu
J Trauma Inj. 2022;35(4):255-260.   Published online November 16, 2022
DOI: https://doi.org/10.20408/jti.2022.0043
  • 1,418 View
  • 49 Download
AbstractAbstract PDF
Purpose
To determine the incidence and risk factors of postoperative infection after cranioplasty in patients with traumatic brain injury (TBI).
Methods
Data of 289 adult patients who underwent cranioplasty after TBI at a single regional trauma center between year 2018 and 2021 were reviewed retrospectively. Patient characteristics and various procedural variables, such as interval between craniectomy and cranioplasty, estimated blood loss, laterality and materials of the bone flap, and duration and classification of perioperative antibiotics usage were analyzed.
Results
Postoperative infection occurred in 17 patients (5.9%). Onset time of infectious symptom ranged from 9 days to 174 days (median, 24 days) after cranioplasty. The most common cultured organism was Staphylococcus aureus (47.1%), followed by Klebsiella pneumoniae (17.6%) and Enterococcus faecalis (17.6%). Patients with postoperative infection were more likely to have diabetes (odds ratio [OR], 6.96; 95% confidence interval [CI], 1.92–25.21; P=0.003), lower body mass index (OR, 0.81; 95% CI, 0.66–0.98; P=0.029), and shorter duration of perioperative antibiotics (OR, 0.83; 95% CI, 0.71–0.98; P=0.026).
Conclusions
For TBI patients with diabetes, poor nutritional status should be managed cautiously for increased risk of infection after cranioplasty. Further studies and discussions are needed to determine an appropriate antibiotics protocol in cranioplasty.
Summary
Age group analysis of patients with dog bite injuries who visited a single regional emergency medical center and factors affecting wound infections
Dong Ho Kang, Jea Yeon Choi, Woo Sung Choi, Jae Ho Jang, Jin-Seong Cho, Sung Youl Hyun
J Trauma Inj. 2022;35(2):84-91.   Published online May 17, 2022
DOI: https://doi.org/10.20408/jti.2021.0046
  • 2,355 View
  • 54 Download
AbstractAbstract PDF
Purpose
The aim of this study was to analyze by age group the characteristics of patients with dog bite injuries, as well as determine which factors were associated with wound infections in those patients.
Methods
We reviewed patients with dog bite injuries who presented to Gachon University Gil Medical Center in Incheon, Korea from January 1, 2014 to December 31, 2018. They were classified by age group: children (0–18 years), adults (19–59 years), or elderly (≥60 years). Event profiles, wound characteristics, and infections were compared across these age groups. Multivariable logistic regression was used to identify factors associated with wound infections.
Results
Of the total 972 dog bite injuries, 272 (28.0%) were in children, 606 (62.3%) were in adults, and 94 (9.7%) were in the elderly. The median age was 30 years (interquartile range, 16–48 years) and the majority of patients (60.5%) were female. The most common place of injury was at home (73.8%) and indoors (77.0%). In children, the head and neck were the most frequent sites of injury (43%), while the most frequent site in adults and the elderly (50.8% and 59.6%, respectively) was the upper extremity. The odds ratio (OR) for wound infection was 3.997 (95% confidence interval [CI], 1.279–12.491; P=0.017) for head and neck injuries and 3.881 (95% CI, 1.488–10.122; P=0.006) for lower extremity injuries. The OR for wound infection was 4.769 (95% CI, 2.167–10.494; P<0.001) for significant injuries. Elderly patients had a higher risk for wound infection than other age groups (OR, 2.586; 95% CI, 1.221–5.475; P=0.013).
Conclusions
When analyzing patients with dog bite injuries, differences across age groups were found, with the elderly at the highest risk for significant injury and wound infection. It is recommended that age-specific approaches and strategies be used to prevent dog bite wound infections.
Summary
Feasibility of Early Definitive Internal Fixation of Pelvic Bone Fractures in Therapeutic Open Abdomen
Kyunghak Choi, Kwang-Hwan Jung, Min Ae Keum, Sungjeep Kim, Jihoon T Kim, Kyu-Hyouck Kyoung
J Trauma Inj. 2020;33(1):18-22.   Published online March 30, 2020
DOI: https://doi.org/10.20408/jti.2019.044
  • 4,587 View
  • 99 Download
AbstractAbstract PDF
Purpose

Damage control laparotomy has contributed to improved survival rates for severe abdominal injuries. A large part of severe abdominal injury occurs with a concomitant pelvic bone fracture. The safety and effectiveness of internal fixation of pelvic bone fracture(s) has not been established. The aim of the present study was to evaluate infection risk in the pelvic surgical site in patients who underwent emergent abdominal surgery.

Methods

This single-center retrospective observational study was based on data collected from a prospectively maintained registry between January 2015 and June 2019. Patients who underwent laparotomy and pelvic internal fixation were included. Individuals <18 and ≥80 years of age, those with no microbiological investigations, and those who underwent one-stage abdominal surgery were excluded. Comprehensive statistical comparative analysis was not performed due to the small number of enrolled patients.

Results

A total of six patients met the inclusion criteria, and the most common injury mechanism was anterior-posterior compression (67%). The average duration of open abdomen was 98 hours (range, 44–198), and the time interval between abdominal closure and pelvic surgery was 98 hours. One patient (16.7%) died due to multi-organ dysfunction syndrome. Micro-organisms were identified in the abdominal surgical site in five patients (83%), with no micro-organisms in pelvic surgical sites. There was no unplanned implant removal.

Conclusions

Internal fixation of pelvic bone fracture(s) could be performed in the state of open abdomen, and the advantages of early fixation may countervail the risks for cross contamination.

Summary
A Peripherally Inserted Central Catheter is a Safe and Reliable Alternative to Short-Term Central Venous Catheter for the Treatment of Trauma Patients
Dong Yeon Ryu, Sang Bong Lee, Gil Whan Kim, Jae Hun Kim
J Trauma Inj. 2019;32(3):150-156.   Published online September 30, 2019
DOI: https://doi.org/10.20408/jti.2019.015
  • 6,583 View
  • 127 Download
  • 3 Citations
AbstractAbstract PDF
Purpose

To determine whether a peripherally inserted central catheter (PICC) meets the goals of a low infection rate and long-term use in trauma patients.

Methods

From January 2016 to June 2018, the medical records of patients who underwent central venous catheterization at a level I trauma center were retrospectively reviewed. Data collected included age, sex, injury severity score, site of catheterization, place of catheterization (intensive care unit [ICU], emergency department, or general ward), type of catheter, length of hospital stay during catheterization, types of cultured bacteria, time to development of central line-associated bloodstream infection (CLABSI), and complications.

Results

During the study period, 333 central vein catheters (CVC) were inserted with a total of 2,626 catheter-days and 97 PICCs were placed with a total of 2,227 catheter-days. The CLABSI rate was significantly lower in the PICC group when the analysis was limited to patients for whom the catheter was changed for the first time in the ICU after CVC insertion in the ER with similar indication and catheter insertion times (18.6 vs. 10.3/1,000 catheter-days, respectively, p<0.05). The median duration of catheter use was significantly longer in the PICC group than in the CVC group (16 vs. 6 days, respectively, p<0.05).

Conclusions

The study results showed that the duration of catheter use was longer and the infection rate were lower in the PICC group than in the CVC group, suggesting that PICC is a safe and reliable alternative to conventional CVC.

Summary

Citations

Citations to this article as recorded by  
  • Anatomical Structures to Be Concerned With During Peripherally Inserted Central Catheter Procedures
    Dasom Kim, Jin Woo Park, Sung Bum Cho, Im Joo Rhyu
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
  • The incidence and risk of venous thromboembolism associated with peripherally inserted central venous catheters in hospitalized patients: A systematic review and meta-analysis
    Anju Puri, Haiyun Dai, Mohan Giri, Chengfei Wu, Huanhuan Huang, Qinghua Zhao
    Frontiers in Cardiovascular Medicine.2022;[Epub]     CrossRef
  • Peripherally Inserted Central Catheter lines for Intensive Care Unit and onco-hematologic patients: A systematic review and meta-analysis
    Georgios Mavrovounis, Maria Mermiri, Dimitrios G Chatzis, Ioannis Pantazopoulos
    Heart & Lung.2020; 49(6): 922.     CrossRef

J Trauma Inj : Journal of Trauma and Injury