• Journal of Trauma and Injury
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• v.31 no.2
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• pp.82-86
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• 2018

Craniocerebral gunshot injuries (CGIs) are extremely seldom happened in Korea because possession of individual firearm is illegal. So, CGIs are rarely encountered by Korean neurosurgeons or Korean trauma surgeons, though in other developing countries or Unites states of America their cases are indefatigably increasing. Management goal should focus on early aggressive, vigorous resuscitation. The treatments consist of immediate life salvage through correction of coagulopathy, intracranial decompression, prevention of infection and preservation of nervous tissue. There have been few studies involving penetrating CGIs in Korea. Here we present a case of penetrating gunshot wound in Korea. We present a 58-year-old man who was unintentionally shot by his colleague with a shotgun. The patients underwent computed tomography (CT) for assessment of intracranial injury. The bullet passed through the left parietal bone and right lateral ventricle and exited through the posterior auricular right temporal bone. After CT scan, he arrested and the cardiopulmonary resuscitation was conducted immediately. But we were unable to resuscitate him. This case report underscores the importance of the initial clinical exam and CT studies along with adequate resuscitation to make the appropriate management decision. Physicians should be familiar with the various injury patterns and imaging findings which are poor prognostic indicators.

• Clinics in Shoulder and Elbow
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• v.27 no.1
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• pp.3-10
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• 2024

Background: Gunshot-related fractures near the elbow are challenging, and available data to guide the practitioner are lacking. This report analyzes injury patterns and treatment strategies in a case series from a high-volume urban trauma center. Methods: All periarticular gunshot fractures near the elbow treated at a level 1 trauma center from 2014 to 2018 were retrospectively reviewed. Fracture location, patient demographics, concomitant injuries, treatment modalities, and complications were analyzed. Results: Twenty-four patients were identified. All patients received prophylactic antibiotics upon admission and underwent urgent surgical debridement. Open reduction and internal fixation (ORIF) was performed with initial debridement in 22 of 24 patients. Seven patients sustained distal humerus fractures, 10 patients sustained isolated proximal ulna or proximal radius fractures, and seven had combined fracture patterns. Eleven patients presented with nerve palsy, and two had transected nerves. Two patients had vascular injury requiring repair. One patient required a temporary elbow-spanning external fixator and underwent staged debridement followed by ORIF. One patient with a grade IIIC fracture developed a deep infection that precluded ORIF. One patient required revision ORIF due to fracture displacement. Conclusions: This investigation reports on management of ballistic fractures near the elbow at a busy urban level I trauma center. Our management centered on rapid debridement, early definitive fixation, and intravenous antibiotic administration. We report on associated neurovascular injury, bone loss, and other challenges in this patient population. Level of evidence: IV.

• Journal of Trauma and Injury
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• v.25 no.2
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• pp.57-62
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• 2012

Gunshot wounds are rare in Korea, but they have tended to increase recently. We experienced an interesting case of penetrating gunshot injuries to the cervical spine with migration the fragments of the bullet within the dural sac of the cervical spine, so discuss the pathomechanics, treatment and complications of gunshot wounds to the spine and present a review of the literature. A 38-year-old man who had tried to commit suicide with a gun was admitted to our hospital with a penetrating injury to the anterior neck. the patient had quadriplegia. A Computed tomography (CT) scan and 3-dimensional CT of the spine showed destruction of the left lateral mass and lamina of the 5th cervical vertebra; the bullet and fragments were found at the level of the 5th cervical vertebra. The posterior approach was done. A total laminectomy and removal of the lateral mass of the 5th cervical vertebrae were performed, and bone fragments and pellets were removed from the spinal canal, but an intradurally retained pellets were not totally removed. A dural laceration was noted intraoperatively, and CSF leakage was observed, so dura repair was done watertightly with prolene 6-0. The dura repair site was covered with fibrin glue and Tachocomb$^{(R)}$. Immediately, a lumbar drain was done. Radiographs included a postoperative CT scan and X-rays. The postoperative neurological status of the patient was improved compared with the preoperative neurological status. however, the patients developed symptoms of menigitis. He received lumbar drainage(200~250 cc/day) and ventilator care. After two weeks, panperitonitis due to duodenal ulcer perforation was identified. Finally, the patient died because of sepsis.

• Journal of Trauma and Injury
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• v.36 no.3
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• pp.253-257
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• 2023

A century ago, cardiac injuries usually resulted in death. However, despite all the advances in medicine, these injuries still have high mortality and morbidity rates. In the present case, we describe a patient with a bullet injury to the right ventricle who survived at our hospital despite the limitations of our center with regard to modalities and equipment. A 30-year-old man was brought to our emergency department with a bullet wound to his left flank. He was hemodynamically unstable. After only 8 minutes in the hospital and without further investigations he was rushed to the operating room. During laparotomy, a clot was visible in the left diaphragm, which dislodged and caused extensive bleeding. The decision was made to perform a sternotomy in the absence of a sternal saw. An oblique 8-cm injury to the right ventricle was discovered following rapid exploration. It was repaired without the need for cardiopulmonary bypass surgery. After a few days in the hospital, the patient was discharged home. In the event of a penetrating cardiac injury, rapid decision-making is crucial for survival. Whenever possible, the patient should be transferred to the operating room, as emergency department thoracotomies are associated with a high mortality rate.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.120-123
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• 2008

A 60-year-old man with a history of gunshot vascular injury on the right inguinal area, and this happened in the military service 40 years ago, was admitted to our hospital with claudication and dyspnea on exertion. The patient was diagnosed with a chronic traumatic femoral arteriovenous fistula. The patient underwent a successful operation for arteriovenous fistula closure with bovine pericardium and for femoropopliteal bypass with using a right greater saphenous vein graft. The patient is well at 14 months after the operation.

• Journal of Trauma and Injury
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• v.34 no.1
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• pp.66-69
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• 2021

When treating firearms injuries, knowledge of the proper management is important because these injuries have high morbidity and mortality. However, due to strict gun safety regulations, surgeons in Asia often have limited experiences with gunshot wound management. Recently, the authors had the experience of removing a bullet that did not cause hemopneumothorax, but remained in the lung parenchyma. Due to the risk of complications that could occur if the bullet was not removed, surgical treatment was eventually performed to remove the bullet. A literature review was needed to determine whether this treatment was appropriate. We concluded that removing the bullet could prevent incidental complications. In this regard, the authors report a case along with a review of the relevant literature to suggest appropriate treatment directions for surgeons who do not have experience with gunshot wounds.

• Journal of Korean Neurosurgical Society
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• v.41 no.1
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• pp.16-21
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• 2007

Objective : Civilian gunshot injuries to the brain are relatively rare and study of these injuries has been neglected in South Korea. We present our experience with penetrating gunshot injuries to the brain and review the outcome of surgical management, as well as other clinical predictors influencing the prognosis. Methods : We present a retrospective analysis of 13 patients with penetrating gunshot injuries to the brain who were treated at our hospital over a period of 22 years. Results : The Glasgow Coma Scale[GCS] score on admission was recorded to be : 3-5 in 1 patient, 6-8 in 3 patients, 9-12 in 2 patients and 13-15 in 7 patients. There were 11 patients who underwent surgical treatment, and the surgical mortality rate was 0%. The admission GCS score was the most valuable prognostic factor. The best results were found to be in patients admitted with an initial GCS higher than 13. There were no favorable outcomes in patients admitted with a GCS of 8 or lower. There was a correlation between the presence of a transventricular or bihemispheric trajectory and poor outcome. The patients admitted with unilobar wounds resulted in better outcome than those with bilobar or multilobar wounds. Retained deep intracranial bone or metal fragments were the most common postoperative complication. However, retained fragments did not increase the risk of infection or seizure. Conclusion : Our results suggest that a less aggressive approach, consisting of minimal local debridement and removal of the bone and metal fragments that are easily accessible, can be successfully used in civilian gunshot wounds to the brain.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.124-127
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• 2008

Injury to the inferior vena cava (IVC) is associated with a high mortality rate, and little progress has been made for improving the treatment for this since the 1970s. Injury to the retrohepatic IVC, in particular, has been associated with up to a 75% mortality rate due to the difficulty in gaining adequate exposure and controlling the bleeding. Both the severity of injury and anatomic accessibility has been directly correlated with survival in IVC injury. We have experienced a patient with retrohepatic IVC that was ruptured by a penetrating gunshot injury and we managed to save this patient's life.

• Journal of Trauma and Injury
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• v.37 no.1
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• pp.67-73
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• 2024

Purpose: Posttraumatic stress disorder (PTSD) is prevalent and is associated with protracted recovery and worse outcomes after injury. This study compared PTSD prevalence using the PTSD Checklist for DSM-5 (PCL-5) with the prevalence of PTSD risk using the Injured Trauma Survivor Screen (ITSS). Methods: Adult trauma patients at a level I trauma center were screened with the PCL-5 (sample 1) at follow-up visits or using the ITSS as inpatients (sample 2). Results: Sample 1 (n=285) had significantly fewer patients with gunshot wounds than sample 2 (n=45) (8.1% vs. 22.2%, P=0.003), nonsignificantly fewer patients with a fall from a height (17.2% vs. 28.9%, P=0.06), and similar numbers of patients with motor vehicle collision (40.7% vs. 37.8%, P=0.07). Screening was performed at a mean of 154 days following injury for sample 1 versus 7.1 days in sample 2. The mean age of the patients in sample 1 was 45.4 years, and the mean age of those in sample 2 was 46.1 years. The two samples had similar proportions of female patients (38.2% vs. 40.0%, P=0.80). The positive screening rate was 18.9% in sample 1 and 40.0% in sample 2 (P=0.001). For specific mechanisms, the positive rates were as follows: motor vehicle collisions, 17.2% in sample 1 and 17.6% in sample 2 (P>0.999); fall from height, 12.2% in sample 1 and 30.8% in sample 2 (P=0.20); and gunshot wounds, 39.1% in sample 1 and 80.0% in sample 2 (P=0.06). Conclusions: The ITSS was obtained earlier than PCL-5 and may identify PTSD in more orthopedic trauma patients. Differences in the frequency of PTSD may also be related to the screening tool itself, or underlying patient risk factors, such as mechanism of injury, or mental or social health.

• Journal of Trauma and Injury
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• v.35 no.2
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• pp.131-138
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• 2022

Other than gunshot injuries, sacral penetrating injuries with a foreign body exiting to the other side are extremely rare. We encountered a case of sacral injury in which a long metallic pipe penetrated from the anus into the lower back of a patient. Since the pelvis contains various organs, management of a penetrating injury requires multidisciplinary treatment involving several medical specialties. Due to the infrequency of this type of injury, there are no definitive guidelines for effective management. We described our experience surgically treating a sacral penetrating injury and conducted a literature review. On this basis, we suggest a surgical strategy for treating this type of injury.