• Journal of the Korean Society of Safety
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• v.23 no.2
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• pp.72-80
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• 2008

In a case of an automobile collision, vehicle damage and injury of the driver and the passenger occur. The scale of the collision which is effected by the extent of vehicle damage and the injury of the passenger, depends on the delta-V. Based on the photograph interpretation o the actual case of accidents in the Seoul and the Incheon area, this study measured the depth of crush and calculated the delta-V. Through verifying the correlation of the depth of crush and the change of velocity, relative equation was evaluated and compared with the prior study results to prove that they are almost identical. Thus, the depth of crush can be used as an index of the degree of impact, which can be utilized as the change of velocity to evaluate the level of injury done to the passengers. However, the period of hospitalization and diagnostics claimed by the injured proves to have no correlation with the delta-V and the extent of vehicle damage, this is due to the non-objective way of diagnosis and the anamnesis of the injured. This study established the absolute limit harmlessness and the choosing limit harmlessness, allowing the appraisal for Yes or No of the injury or the harmlessness based on the prior studies. Moreover, utilizing the relative equation formed between the depth of crush and the delta-V, each case of collision was compared and evaluated in comparison to the limit harmlessness to prove that the 90.4% of the so-called 'claiming-to-be-injured' were exaggerating or fabricating.

• Journal of Trauma and Injury
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• v.35 no.3
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• pp.209-214
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• 2022

We describe a case of hyperbaric oxygen therapy (HBOt) as an adjunct to treatment of a crush injury to the hand. A 34-year-old male paramedic was involved in a motor vehicle accident and admitted for diagnosis and surgical treatment. He sustained a crush injury to his right hand and presented with significant muscle damage, including multiple fractures and dislocations, an avulsion injury of the flexor tendons, and amputation of the distal phalanx of the little finger. He underwent reconstructive surgery and received HBOt over the following days. In the following 2 months, he lost the distal and middle phalanges of the little finger and recovered hand function. Posttraumatic compartment syndrome responds well to HBOt, which reduces edema and contributes to angiogenesis, as well as promoting the cascade of healing events. High-energy trauma causes massive cell destruction, and the blood supply is usually not sufficient to meet the oxygen demands of viable tissues. Hyperbaric oxygenation by diffusion through interstitial and cellular fluids increases tissue oxygenation to levels sufficient for the host's responses to injury to work and helps control the delayed inflammatory reaction. HBOt used as an adjunct to surgical treatment resulted in early healing and rehabilitation, accelerating functional recovery. The results suggest that adjunctive HBOt can be beneficial for the treatment of crush injuries of the hand, resulting in better functional outcomes and helping to avoid unnecessary amputations.

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.95-101
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• 1998

From march 1993 to march 1998, twenty consecutive transmetacarpal replantations and revascularizations were reviewed retrospectively. Nine patients sustained severe and diffuse crush injuries, four patients had local crush injuries, and seven suffered guillotine type amputation. Six replantations and fourteen revascularizations were performed. 76 of 81 replantable digits(93%) were salvaged. 15 patients required secondary surgery, 10 patients for tendon and joint scarring and 5 for nonunions or malunions. Intrinsic muscle function and pinch and grip strengths were weak or absent. According to Chen's grading system of functional return, 2(10%) were grade I, 6(30%) were grade II, 10(50%) were grade III, and 2(10%) grade IV. The follow-up period ranged from 6months to 46 months. Only 3 patients resumed his prior occupation(one as a supervisor); 2 were permanently disabled, 4 pursued new occupations as a manual worker, 1 were still in therapy. Only two of the manual laborers were able to return to their preinjury occupation. Despite these unacceptable functional results, all patients were satisfied with the surgery.

• Journal of Trauma and Injury
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• v.32 no.3
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• pp.168-171
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• 2019

The treatment outcome remains poor of severe facial injuries because of the high risk of compromised airway or massive bleeding. We experienced two successful treatment cases of severe facial injury by the chainsaw. A 52-year-male had his face injured by the chainsaw during his work. He was transferred to the Level I trauma center using the Doctor-Helicopter. During his flight, bleeding control was tried and the information was given to the trauma surgeons before his arrival. His consciousness was alert and the vital signs were stable. The crushing wound, mandible open fracture, deep laceration of tongue, lip, neck and arterial bleeding were noted around his mandible. Nasotracheal intubation was performed under the bronchoscope-guided. Emergency operation (open reduction & internal fixation, primary repair with neurorrhaphy) was performed. At 30 hospital days, he was discharged with facial palsy on left mandibular area. A 30-year-male had his face injured by the chainsaw. He was transferred to our Level I trauma center from the local hospital. The deep-mutiple lacerations on right upper eyelid and forehead with the bony exposure were noted. The vital signs were stable and emergency operation was performed. He was discharged at 20 hospital days. Bone loss or tissue loss were not devastating than we expected even though the injury was occurred by the chainsaw. Aggressive treatment including airway manipulation or bleeding control and maximal opportunity of therapy are absolutely needed.

• Journal of Korean Dental Science
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• v.6 no.2
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• pp.58-66
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• 2013

Purpose: The inferior alveolar nerve (IAN) can be damaged as a result of minor oral surgical procedure such as third molar extraction or implant placement. Repair of the injured IAN involves difficulty of access, and research studies are limited to elucidating the process of regeneration by surgical methods. This study sought to establish the rabbit animal model to apply polymeric membrane functionalized with nerve growth factor after a crush lesion for the evaluation of nerve regeneration using the electrophysiologic method. Materials and Methods: The IAN of 2 adult male New Zealand white rabbits (4 nerves) were exposed bilaterally, and crush injury rendered by jeweler's forceps was applied. Nerve conduction velocity was examined electrophysiologically using electromyography before, after, and 4 weeks after the crush injury. To evaluate the regeneration, the pattern of action potential of IAN was recorded, and the characteristics of neurons were histologically observed. Result: After the crush injury, afferent activity decreased in the injured group. Electromyography could not be recorded after four weeks because tissues surrounding the injured nerve collapsed. Decrease in the mean number of axons was observed in the injured part with membrane. Conclusion: Despite the limited result, the present animal model study may provide a possible way to research on the methods of enhancing the recovery of nerve injuries in clinical situations. For clinically widespread acceptance, however, it should gain more consecutive and scientific evidences.

• Journal of Korean Foot and Ankle Society
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• v.17 no.1
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• pp.34-39
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• 2013

Purpose: To evaluate the effectiveness of intraoperative stress test for diagnosis of occult Lisfranc injury. Materials and Methods: Between April 2009 and October 2012, 21 patients with occult Lisfranc injuries underwent intraoperative stress test and internal fixation. There were 11 males and 10 females with an average age of 45.3 years (range, 23~79 years). Injuries were caused by traffic accident in 10 cases, indirect force (twisting injury) in 8 cases, and crush in 2 cases, falling from a height in 1 case. Unstable injuries on stress radiograph in occult injury of Lisfranc joint were treated by open reduction or closed reduction and fixation with cannulated screw or K-wire. Radiological evaluation was assessed according to preoperative and postoperative diastasis between $1^{st}$ and $2^{nd}$ metatarsal base. Results: Assoicated injuries were 9 cases of metatarsal fractures, 6 cases of cuneiform fractures and 6 cases of both metatarsal and cuneiform fractures. Medial and middle column fixation was in 13 cases, and three columns fixation was in 8 cases. Initial diastasis between $1^{st}$ and $2^{nd}$ metatarsal base was 2.8 mm (1.3~4.7 mm) on AP radiograph and postoperative diastasis between $1^{st}$ and $2^{nd}$ metatarsal base was 1.2 mm (0.5~2.4 mm) on AP radiograph. Conclusion: Even there is no sign of clear Lisfranc injury, it is necessary to pay attention and give evaluation on circumstances of occult Lisfranc injuries with metatarsal or cuneiform fractures. Intraoperative stress test is helpful to diagnose an occult Lisfranc injury. For unstable injuries on stress radiographs of occult Lisfranc joint injury, operative treatment with open or closed reduction and internal fixation is useful method.

• Journal of the Korean Data and Information Science Society
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• v.20 no.5
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• pp.797-807
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• 2009

In a case of an automobile rear-end collision, scale of the collision which are the extent of vehicle damage and the injury of the passenger is affected by the speed change. Based on the photographic interpretation of the actual accident cases in the Seoul and the Incheon area, this study measured the depth of crush and calculated the speed change from the statement data of the accident and speed, and also injury data such as diagnosis, hospitalization days are collected. The period of hospitalization and diagnostics claimed proves to have no statistical correlation with the depth of vehicle crush and speed change. Based on the statistical analysis from this study and previous foreign studies, we found that there have been 78.1% of personal accidents didn't reach the injury threshold. There should be objective information on the scale of accident accepting the claims-to-be-injured in the future, and application of injury threshold level suggested are considered to be very useful.

• Journal of the Korean Society of Radiology
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• v.84 no.4
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• pp.835-845
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• 2023

Traumatic pelvic injuries usually include high-energy crush injuries and are associated with significant morbidity and mortality. Mortality rates range from 6% to 15% and increase to 36%-54% in cases of fractures that result in increased pelvic volume. Therefore, retroperitoneal hemorrhage can spiral and progress to hemorrhagic shock. Pelvic hemorrhage most commonly occurs secondary to disrupted pelvic veins or fractured bones, and 10%-20% of cases involve arterial injuries. Owing to extensive bleeding and limitations of surgery for pelvic hemorrhage, interventional treatment is at the forefront of pelvic hemorrhage management. CT is an accurate indicator of active hemorrhage in patients with pelvic trauma that affects the diagnosis and management, including interventions. Identification of the site of hemorrhage is necessary for focused interventional treatment. The current trend toward a more conservative approach for treatment of pelvic trauma and advances in interventional radiology in the field of pelvic trauma may favor widespread use of interventional treatment for patients with pelvic injuries. In this review, we discuss therapeutic modalities available to the interventional radiologist and common angiographic treatment strategies and techniques.

• Archives of Plastic Surgery
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• v.47 no.5
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• pp.451-459
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• 2020

Background For volar soft tissue defects of the proximal interphalangeal (PIP) joint, free flaps are technically challenging, but have more esthetic and functional advantages than local or distant flaps. In this study, we compared the long-term surgical outcomes of arterial (hypothenar, thenar, or second toe plantar) and venous free flaps for volar defects of the PIP joint. Methods This was a single-center retrospective review of free flap coverage of volar defects between the distal interphalangeal and metacarpophalangeal joint from July 2010 to August 2019. Patients with severe crush injuries (degloving, tendon or bone defects, or comminuted/intra-articular fractures), thumb injuries, multiple-joint and finger injuries, dorsal soft tissue defects, and defects >6 cm in length were excluded from the study, as were those lost to follow-up within 6 months. Thirteen patients received arterial (hypothenar, thenar, or second toe plantar) free flaps and 12 received venous free flaps. Patients' age, follow-up period, PIP joint active range of motion (ROM), extension lag, grip-strength ratio of the injured to the uninjured hand, and Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score were compared between the groups. Results Arterial free flaps showed significantly higher PIP joint active ROM (P=0.043) and lower extension lag (P =0.035) than venous free flaps. The differences in flexion, grip strength, and QuickDASH scores were not statistically significant. Conclusions The surgical outcomes of arterial free flaps were superior to those of venous free flaps for volar defects of the PIP joint.

• Archives of Plastic Surgery
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• v.44 no.2
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• pp.117-123
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• 2017

Background Upper extremity soft tissue defects with complete circumferential involvement are not common. Coupled with the unique anatomy of the upper extremity, the underlying etiology of such circumferential soft tissue defects represent additional reconstructive challenges that require treatment to be tailored to both the patient and the wound. The aim of this study is to review the various options for soft tissue reconstruction of complete circumferential defects in the upper extremity. Methods A literature review of PubMed and MEDLINE up to December 2016 was performed. The current study focuses on forearm and arm defects from the level at or proximal to the wrist and were assessed based on Tajima's classification (J Trauma 1974). Data reviewed for analysis included patient demographics, causality, defect size, reconstructive technique(s) employed, and postoperative follow-up and functional outcomes (when available). Results In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 14 unique articles were identified for a total of 50 patients (mean=28.1 years). Underlying etiologies varied from extensive thermal or electrical burns to high impact trauma leading to degloving or avulsion, crush injuries, or even occur iatrogenically after tumor extirpation or extensive debridement. Treatment options ranged from the application of negative pressure wound dressings to the opposite end of the spectrum in hand transplantation. Conclusions With the evolution of reconstructive techniques over time, the extent of functional and aesthetic rehabilitation of these complex upper extremity injuries has also improved. The proposed management algorithm comprehensively addresses the inherent challenges associated with these complex cases.